Radiology Departments as COVID-19 entry-door might improve healthcare efficacy and efficiency, and Emergency Department safety

Abstract

Background: Possible COVID-19 pneumonia (ppCOVID-19) patients generally overwhelmed EDs during the first COVID-19 wave. Home confinement and primary care phone follow-ups were the first-level regional policies for preventing EDs from collapsing. However, when ppCOVID-19 needed X-ray assessment, the traditional outpatient workflow at the radiology department (RD) was inefficient and raised concerns about potential interpersonal infections. We aimed to assess the efficiency of a primary care high-resolution radiology service (pcHRRS) for ppCOVID-19 in terms of time consumed at the hospital and decision reliability.Methods: We assessed 849 consecutive ppCOVID-19 patients, 418 appointed by general practitioners to the pcHRRS (home-confined ppCOVID-19 cases with negative –group-1- and positive -group-2- X-ray results) and 431 arriving at the ED by themselves (group-3). The pcHRRS provided X-rays and oximetry in an only-one-patient agenda for home-confined ppCOVID-19 patients. Radiologists made next-step decisions (group-1: pneumonia-, home-confinement follow-up; group-2: pneumonia+, ED assessment) according to X-ray results. ANOVA and Bonferroni correction, Student’s t-test, Kruskal-Wallis test, and Chi2 test were used to analyse changes in the ED workload, time-to-decision differences between groups, and pcHRRS performance for discriminating need for 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 vs. 3:50±3:16 h; group-1 vs. all group-2 and group-3 patients: 0:41±1:05 h vs. 5:36±4:36 h; group-2 vs. group-3 admitted patients: 5:27±3:08 h vs. 7:42±5:02 h; P <0.001) and prompted admission in most cases (84/93, 90.3%).Conclusions: A Radiology Department pcHRRS may be a more efficient entry-door for ppCOVID-19 by decreasing ED patients and making expedited decisions while guaranteeing social distance.