Pre-Covid-19, we were screening about 2,200 patients per day in our offices. By week 2, we were down to 1,832, by week 3 we were down to 1,090, and as of [March 26], we were down to 722.
On the state of New Jersey’s map of coronavirus infections, University Radiology Group’s (URG) service area overlaps precisely the hardest hit counties. During his segment of the Covera Health webinar on March 26, “Managing Covid-19 on the Front Lines,”Sandip Basak, MD, president, University Radiology Group, offered a chilling account of a busy, thriving practice serving multiple hospitals and imaging centers devolving into a skeleton crew intent on protecting patients, employees, shareholders, and locations during the Covid-19 siege.
URG is a 140-radiologist practice with 744 employees that interprets 1.8 million radiology exams annually in 10 hospitals and 22 ambulatory offices including an academic medical center. Its first introduction to the virus was on Feb 14. “We had an employee in China, 461 miles east of Wuhan,” Dr. Basak said. “She was there since January 1, and not returning until February 25th, and wanted to know what do on her return. Our director of nursing emailed our infectious disease consultant and the answer was 14-day quarantine.”
Dr. Basak then outlined actions taken during the next three weeks, providing useful insights on protocols for screening patients, managing referrals, determining essential versus non-essential imaging, and protecting staff from illness.
Week 1: March 1-7—A Growing Sense of a Threat Abroad
With concern growing over the situation in China and Europe, URG held its first internal meeting in response to the threat. “We really had more questions than answers,” he shared, but the meeting resulted in two employee communications based on CDC guidelines which:
“We did not institute verbal screening of patients at this time,” he said.
Week 2: March 8-14—From Recognition to Action
As URG moved into the second week, the practice experienced a major pivot in its perspective of the pandemic, significantly escalating the organization’s preparation. They:
Based on discussions with Dr. Mickey, URG made the following changes to screening guidelines:
This discussion also informed the reversal of a decision to quarantine all employees of an imaging center in Teaneck and close the location. The manager of the Teaneck location had no symptoms, but her husband was sick, and a sibling had tested positive and was hospitalized. The manager self-quarantined and based on consultation with the NJ Department of Health and the infectious disease consultant—who recommended quarantining the entire staff for second degree exposure—the center was closed.
“Within 24 hours, we decided that this was not the best way to go, that quarantining second- and third-degree exposure would not be tenable long term,” Dr Basak shared. “We reversed the decision the next day.”
Meanwhile, the following policies and recommendations were issued:
URG interpreted the ACR advisory to pertain primarily to hospitals and surgery centers to allow for mobilization and conservation of PPE, medical equipment, and clinical resources and did not restrict procedures at its imaging center locations. “We continued to do diagnostic imaging including screening and diagnostic mammography,” Dr. Basak said.
URG did implement the following clinical care policies:
Week 3: March 16-20—Screening Volumes Declined by Half
By week three, the vast majority of URG’s business office employees were working from home, as were many radiologists. At the beginning of the week, office staff remained relatively unchanged, but management quickly realized that office volumes were drastically declining. “Pre-Covid-19, we were screening about 2,200 patients per day in our offices,” Dr. Basak explained. “By week 2, we were down to 1,832, by week 3 we were down to 1,090, and as of [March 26], we were down to 722.”
URG instituted several new policies that week:
URG’s priority in all HR decisions was to protect employee health insurance.
Week 4: March 22-26: Where We Are Now?
As of March 25, office volumes were down 66%, and hospital volumes had declined by 33% and continue to decline.
“It still feels like we are in the fog of war,” Dr. Basak said. “By the end of this week we will have closed 9 offices and significantly reduced hours in all others. We expect additional office closures next week.” URG also made the decision to:
Over the past three weeks, seven employees have been quarantined—currently down to just three—all asymptomatic with no conversions. “Luckily,” Dr. Basak noted. “We’ve allowed our staff to wear masks upon request, but we have not required it, recognizing the shortage of PPE.” Daily Covid-19 meetings continue.
“I’ve gone over numerous difficult and troubling concepts,” Dr. Basak concluded. “I want to remind everyone that this crisis will end, but before we finish, I can share a few insights from University Radiology.”
Dr. Basak thanked everyone at URG for their patience, understanding, and tolerance during this very difficult time.
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