Radiology departments as COVID-19 entry-door might improve healthcare efficacy and efficiency, and emergency department safety

• Published in: Insights into imaging Vol. 12; no. 1; p. 1
• Main Authors: García Santos, José M., Plasencia Martínez, Juana M., Fabuel Ortega, Pablo, Lozano Ros, Marina, Sánchez Ayala, María Carmen, Pérez Hernández, Gloria, Menchón Martínez, Pedro
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 04.01.2021; Springer Nature B.V; SpringerOpen
• Subjects: Confinement; Coronavirus; Coronaviruses; COVID-19; Decision analysis; Diagnostic Radiology; Emergency exits; Emergency medical services; Emergency medicine; Imaging; Internal Medicine; Interventional Radiology; Medicine; Medicine & Public Health; Neuroradiology; Original; Original Article; Oximetry; Pneumonia; Primary health care; Radiology; Reliability analysis; Time response; Ultrasound; Workflow; X-rays; COVID-19; Radiology; Coronavirus; Primary health care; Emergency medicine
• ISSN: 1869-4101; 1869-4101
• DOI: 10.1186/s13244-020-00954-8

Background Possible COVID-19 pneumonia patients (ppCOVID-19) generally overwhelmed emergency departments (EDs) during the first COVID-19 wave. Home-confinement and primary-care phone follow-up was the first-level regional policy for preventing EDs to collapse. But when X-rays were needed, the traditional outpatient workflow at the radiology department was inefficient and potential interpersonal infections were of concern. We aimed to assess the efficiency of a primary-care high-resolution radiology service (pcHRRS) for ppCOVID-19 in terms of time at hospital and decision’s reliability. Methods We assessed 849 consecutive ppCOVID-19 patients, 418 through the pcHRRS (home-confined ppCOVID-19 with negative—group 1- and positive—group 2-X-rays) and 431 arriving with respiratory symptoms to the ED by themselves (group 3). The pcHRRS provided X-rays and oximetry in an only-one-patient agenda. Radiologists made next-step decisions (group 1: pneumonia negative, home-confinement follow-up; group 2: pneumonia positive, ED assessment) according to X-ray results. We used ANOVA and Bonferroni correction, Student T, Chi 2 tests to analyse changes in the ED workload, time-to-decision differences between groups, potential delays in patients acceding through the ED, and pcHRRS performance for deciding admission. Results The pcHRRS halved ED respiratory patients (49.2%), allowed faster decisions (group 1 vs. home-discharged group 2 and group 3 patients: 0:41 ± 1:05 h; 3:36 ± 2:58 h; 3:50 ± 3:16 h; group 1 vs. all group 2 and group 3 patients: 0:41 ± 1:05 h; 5.25 ± 3.08; 5:36 ± 4:36 h; group 2 vs. group 3 admitted patients: 5:27 ± 3:08 h vs. 7:42 ± 5:02 h; all p  < 0.001) and prompted admission (84/93, 90.3%) while maintaining time response for ED patients. Conclusions Our pcHRRS may be a more efficient entry-door for ppCOVID-19 by decreasing ED patients and making expedited decisions while guaranteeing social distance.