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A Review with Dr. Carla Harmath, Chief of Abdominal Imaging
Dr. Carla Harmath oversees the quality of work, as well as the operations and logistics, in all abdominal imaging and procedures performed. She believes that her ancillary staff, especially the radiology technologists, are the greatest assets of the hospital. Her job is to make sure that her staff is protected, and patients taken care of. Enter the pandemic, where safety became a life or death concern in a department that typically operates in a low risk environment.
Radiology was the first to ramp up at the University of Chicago because there is no safer option for radiology. Clinicians can do some virtual visits, but radiology requires patients onsite to have their MRI, CT exams or ultrasound scans. We had to act – we have several patients in clinical trials for cancer and they cannot wait to have their follow-up imaging exams as they need to adapt treatment. We also did not patients that were sick waiting for care. Our patients needed us to do something.
Dr. Harmath walks us through the critical areas of focus she set in motion for her team and department as they reopened radiology services at the University of Chicago.
- Visitor Policy: Only patients with a caregiver were allowed entry. Policies excluding outside vendors like drug reps remain in place.
- Reconfigure the physical space: Radiology cannot be performed remotely. Patients must come into the department to have their exams done. We had to rearrange the registration desks and waiting area furniture to assure social distancing. We placed chairs at least six feet apart from each other. The floors were also marked for social distancing and we restricted the elevator’s capacity to a maximum of four people. We moved removed any reading material from the waiting areas to avoid people touching the same things over and over. We minimized patients filling out forms and sharing pens by adopting verbal consent remote check-in questionnaires and recommendations for pre or post exam. And we placed barriers between reception and patients for necessary contact.
- Cleaning: Increased frequency of cleaning waiting areas. While healthcare facility cleaning happens at a more frequent rate to begin with, we’ve increased this in response to the pandemic. We installed touchless sanitizing stations throughout the hospital and will be adding self-cleaning surfaces, air conditioning reversal, and increased review of environmental service devices.
- Patient Entry: Every patient or visitor is greeted at the entrance by hospital personnel with a questionnaire. Individuals must attest that they do not have any symptoms (fever, cough, runny nose) prior to entry and submit to a temperatures check. If they have a fever, we reschedule testing as well as evaluate potential treatment for anyone that interacted with that individual.
- Staff Entry: Every time staff enters the hospital, they must also attest to not having any symptoms. We indicate this by tapping our badges at the entry side. We have to hand sanitize and have our temperature checked every time we come in it, even if it just did.
- Universal Masking: No one is allowed in without a mask. Staff, patients, and visitors alike.
- Telehealth: Do everything you can to minimize the patient’s time in the hospital. Have them arrive at the exact time of their appointment. If there any option for remote exams or follow-up, do it.
- High Risk Groups: Have specific plans for these groups, including staff members. We gave these patients the choice of not coming in for their exam if they did not feel comfortable, but we took time to explain that we took all the safety measurements within the recommended guidelines.
- Asymptomatic Patients: Prevent this group from undergoing more invasive radiology procedures to avoid exposing others. Interventional radiology as an example performs a list of higher risk procedures that are aerosolizing (i.e. patients can cough and cannot wear a mask during the procedure). Patients must be tested for COVID prior to these procedures and, even with a negative result, should keep themselves in isolation from the time of scheduling to the time of the exam. All staff involved in performing these procedures must wear protective equipment at all times.
- Infected Patients: Keep COVID patients in a separate unit. Our nurses on these floors have been instrumental in performing portable exams where possible. We have had no adverse events with this safety measurement in place.
- Communicate facts and data: Keep staff updated often. Leadership at the University of Chicago has done a fantastic job updating us through frequent emails with guidelines, capacity data such as how many patients have be onsite, how many have COVID, and how many patients are under investigation as well as our remaining ventilator inventory. We are always aware of how the hospital is doing relative to patient safety.
Dr. Harmath notes that they are constantly working to ensure the hospital is safer than ever. It is nonstop work. We have dealt with highly contagious diseases before, and we all know that we must wash our hands, wear protective gear, and decrease the number of non-essential personnel in house. We have to adapt, including the way we teach residents.
Learning in Crisis
As the University of Chicago reopened, patients were concerned about coming to the hospital and radiology schedules specifically were not full. As they were able to demonstrate safety in the approach, patients returning increased to a point where they had to extend the hours of operation to accommodate everyone. While they had a plan for no shows, surprisingly it wasn’t needed. And the quest to continue learning, and improving, continues as a professor of radiology and world-renowned pioneer in computer aided diagnosis at the University of Chicago recently received a grant to create a method in medical imaging to help better understand, diagnose, and treat COVID-19. The work is supported by a large contract under the National Health Institute, and the nation’s largest medical imaging associations, to develop a medical imaging data resource center.
Most of us know, especially radiologists, that medical imaging provides important information to help detect, diagnose, and mind for diseases. This is the same case with COVID-19. We have learned that test images can help clinicians determine the severity of the infection and an optimal treatment course. This new resource center will collect x-rays and CT scans from thousands of patients, over an open source database, allowing researchers worldwide to access information for COVID-19 research.
Today’s unfortunate and unprecedented situation allows us to continue to deepen our knowledge on how to operate safely, serving our community and patients without significant disruption in their care.