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.
The Covid-19 pandemic appears to have decimated outpatient imaging volumes. With communities across the U.S. in various stages of re-opening for business, Strategic Radiology (SR) member practices with outpatient assets are beginning to carefully and mindfully take steps to safely resume non–Covid-related imaging of patients.
In a retrospective review of imaging volumes during the 16 weeks between January 1 and April 18 by Naidach et al, Northwell Health, a large New York health system, saw the greatest decline registered in outpatient imaging (-88%) during week 16, with mammography (-94%), nuclear medicine (85%), and MRI (-74%) hit the hardest. In nearby New Brunswick, NJ, Sandip Basak, MD, president of SR member group University Radiology, reported a 66% decline in office volumes by March 22 during a webinar that shared early Covid experiences.
"Pre-Covid-19, we were screening about 2,200 patients per day in our offices," he said. "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.
In Maryland, new SR member and all-outpatient practice Chesapeake Medical Imaging (CMI) with 13 outpatient sites experienced abrupt and “huge” declines in volume followed by commensurate reductions in revenue a few weeks later. “That has been a challenge,” notes Mark Baganz, MD, CEO. “It is not just medicine, not just radiology, it is all sectors, whether retail, restaurants, manufacturing. How do you survive a catastrophic event from the business standpoint? We have had to be very careful.”
“Maryland is beginning to open back up, and we are seeing patient volumes start to ramp up,” he continued. “We are able to respond more quickly than the larger organizations in returning back to more normal operations, so we are going to be OK.”
The biggest challenge has been keeping patients and staff not just feeling safe but actually being safe and as protected as possible, said Dr. Baganz. “We’re learning new workflows where we have essentially closed down our waiting rooms and used our parking lots as waiting rooms,” he reports. “We’ve been fortunate enough to have the geography where most of our offices have a parking lot right outside the main office door.”
Webinar: Patient Safety Best Practices
Quality teams from a number of SR practices gathered online recently to share steps taken to keep patients and staff as safe by guarding against all potential vulnerabilities during a webinar conducted within the SR Patient Safety Organization by Executive Director Lisa Mead, RN, CPHQ. One bright note is that all practices report having adequate patient protective equipment for patient-facing radiologists and staff.
Pre-screening and Registration
Policy for Walk-in Patients
Use of Signage
Room Turnaround Process
Keeping Radiologists Safe
Comeback Task Force
Mead asked members if they had a plan in place for a repeat de-engagement of non-urgent care in the event of a second surge. One practice reported that they had implemented a Comeback Task Force that meets several times a week to review data, including number of cases, number of hospitalizations, and number of deaths.
“Keeping data part of the plan is best practice,” said Mead. “Also, remember that it is important to keep written plans as part of your Patient Safety Evaluation Systems (PSES), and important to have a plan ready to put into action based on triggers—these could be a state or local edict.”
Mead subsequently hosted another Covid-19-related related webinar that featured Peggy Binzer, JD, executive director of the Alliance for Quality Improvement and Patient Safety (AQIPS), "Preparing for the Upcoming Covid-19 Litigation." While Mead does not expect radiology to be a primary target, it will be a good opportunity to review relevant legislation, including the PREP Act that emerged after the Katrina disasters and immunity declarations and how they work, and the importance of member groups’ Patient Safety Evaluation Systems, the system the practice uses to document how it analyzes and deliberates patient safety and quality information in a privileged and confidential manner. Binzer also will address the steps SR-PSO members need to take to protect metadata, or EHR audit trails, as Patient Safety Work Product.
Hub is the monthly newsletter published for the membership of Strategic Radiology practices. It includes coalition and practice news as well as news and commentary of interest to radiology professionals.
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