A recent ASNC webinar on the topic of COVID-19 preparedness for nuclear labs featured a panel of experts in the field. The session explored how to address the pandemic within your nuclear department. Here’s a closer look:
Before the Imaging Procedure
Here in the US, we’re faced with multiple challenges associated with COVID-19 in the healthcare field. Stephen A. Bloom, M.D., FASNC highlighted that, to begin with, we’ve had ongoing issues with lack of testing availability for COVID-19. That has hampered efforts to track the spread of the virus and puts both patients and healthcare workers at risk.
Secondly, we’re contending with shortages of PPE, especially N95 masks. These factors alone mean that the safest approach before any imaging is to only go ahead if it is expected to provide a clinical benefit. This means most elective tests can be postponed until a later time.
If you choose to continue offering elective imaging, any patients with recent exposure to others with COVID-19, or who have any symptoms of the virus should be postponed. The suggestion of clinicians worldwide is to limit the numbers coming in to minimize the chances of exposure though.
Another thing to consider is that common-sense protocols for protecting against COVID-19 mean that you can’t screen as many patients in a day. All equipment must be thoroughly cleaned between patients, which can take 60-90 minutes. Dr. Bloom stresses that determining who to test and when to test is up to individual physicians, it may be better to only take emergencies.
Where you need to continue with imaging, thorough pre-screening is a must. A three-step procedure can involve:
- Gathering the epidemiological history of the patient, including any travel, contact with known coronavirus patients or whether they live within a known cluster.
- Checking for clinical manifestations
- Classifying the patients:
- Ordinary patients – no epidemiological history or clinical manifestations
- Potential risk patients – Any epidemiological history with no clinical manifestations
- Suspected patients – epidemiological history and 2-3 clinical manifestations
- Confirmed patients – with a positive test
This should be carried out before they come in for an appointment.
Patient Arrival at the Clinic
Here is a suggested procedure for patients that have been through pre-screening and arrive at your facility for imaging:
- Get a written declaration form for their health history in relation to COVID-19. A legal declaration can encourage people to take an honest approach.
- Check the patient’s temperature – those with a raised temperature should be screened out.
- The front desk should screen the patient and anyone accompanying them.
- Observe segregation/social distancing for patients and staff. Especially segregate high-risk cardiology and oncology patients.
- Observe hygiene. Handwashing and/or sanitizing should be available to patients. Waiting areas, the imaging room and the stress test room should be sanitized before they come in.
An additional option for facilities would be to move the imaging services outside the clinic. Many mobile imaging providers, like DMS Health, are being contacted to deploy their mobile fleet immediately.
Healthcare facilities are choosing to go this route in order to limit the amount of foot traffic into their facility and opting to have the patients remain in their cars, outside of the mobile imaging unit, until it is their turn to be imaged.
It’s important to keep our technologists as safe as possible. Pre-screening plays a huge role in this, and one thing you can do is find ways to limit the amount of time technologists spend with patients.
For example, procedures can be explained over the phone prior to the appointment. This can cut down on face-time during the appointment. Another thing to do is to rotate technologist teams in and out, helping to limit staff exposure.
It’s important that someone takes a leadership role for the clinic, checking in on social distancing and ensuring that the workplace is configured to allow for it. For example, you might need to rearrange some equipment or furniture to help keep people distant.
That same person may be in charge of monitoring PPE and ensuring that it is used optimally, especially where there is a need to conserve it.
During Stress Testing
As most are well aware, the more physical objects to be handled, the more risk of transmitting a virus. One strategy, if the policies of your facility allow it, is to get verbal consent for stress testing rather than written.
It is also strongly advised that pharmacological options for stress testing be chosen over exercise stress tests. This is because the exercise test increases the risk of droplet exposure, especially for nearby team members monitoring blood pressure and the safety of the patient.
If you have it available, vasodilator testing allows for a shorter test as well as blood pressure monitoring with automatic equipment, allowing for distancing.
Thorough sanitation goes without saying after stress testing. It is important to also think about what you do about interpreting results and communicating with the patient afterwards.
Telemedicine is set to play a huge role. In fact, since the declaration of a national emergency, many of the restrictions that lay around use of telemedicine have been lifted to facilitate social distancing as much as possible. For example, patient consent can be carried out via telemedicine.
Telemedicine allows for a digital copy of the consent form to be sent out to the patient, including during the period before they come in for the procedure. A referral via telemedicine may also be a reimbursable event.
In terms of interpreting the results of imaging, using HIPAA compliant remote connections is a best practice to avoid people having to be at close quarters. Wherever possible, limit the number of people together.
Another important consideration is to pay careful attention to CT, especially for any potential lung findings that might indicate COVID-19. If this can be reviewed before the patient leaves the department, you can quickly communicate this finding with referring physicians and have them contact the patient to outline next steps. You can use screen sharing with referring physicians to show results, too.
Below is a summary of the ASNC best practice guidelines at this time:
There are a few key takeaways from this, largely in minimizing the potential for exposure both for patients and team members.
Non-urgent testing should be postponed until later and for any testing that is required, strict screening and social distancing practices should be followed.
Remote technology is here to help minimize the face-to-face time required. See what your team can do with telemedicine for screening and follow-up to further keep contact to a minimum.