Interventional radiology day case unit; COVID-19

Created - 16.09.2020

Globally since the start of COVID-19 pandemic, there has been challenges in delivering non-COVID-19 related health care services, including the elective and non-urgent Interventional Radiology services. The impact was significant on all interventional radiology procedures due to rationalisation and bed shortage, and in some centres that extended to the non-elective and cancer diagnostic and therapeutic procedures, in some centres these were completely halted.

In our hospital, Royal Stoke Hospital, University Hospitals of North Midlands we have been very fortunate to have a dedicated Radiology day case unit, located within the Interventional Radiology department. Our Radiology Day Case Unit (RDCU) has a 9-bed capacity and is separated into two bays containing 4 and 5 beds, separating females and males patients. It is fully staffed between 07:30 and 22:00 by our interventional radiology nurses and health care assistants, who are rotating to cover the unit. This is supported by the consultant interventional radiologist on-call. The patients are admitted under the care of the operating IR consultant. Our RDCU is complemented by a dedicated Interventional Radiology clinic within the department for pre-procedure and follow-up consultations, as well as nurse-led preassessment clinics for patient optimisation and controlling risk factors prior to the admission. Having an RDCU was very beneficial during the COVID-19 inpatient bed crisis. In our trust, generally all non-acute admissions were prioritised and justified by higher management. Admissions to the RDCU, being a dedicated day case unit were not restricted during bed shortage and rationalisation and that exempted RDCU patients from competing with other specialties. Therefore, RDCU provided an additional resilience to IR services.

Our RDCU has played a critical role in providing safe and effective IR procedures to a wider range of patients than before COVID-19, to compensate for the total shut down of some other services. This was crucial in keeping a steady flow for urgent patients and 2 week-wait diagnostic and therapeutic procedures. The RDCU provided a safe environment for high-risk patients such as those immunocompromised due to organ failure or cancer. In addition, treating these patients as day cases has improved these vulnerable patients’ outcomes as it minimized their hospital stay. This was very beneficial in keeping these patients as outpatients and preventing acute admission, as well as minimizing the risk of cross-infection due to the short admission nature of the RDCU and more rapid recovery.

During the lock-down, we offered full services as day case procedures for urgent and 2-weeks-wait, including TACE, biopsies and other cancer diagnostic procedures, urgent urology and biliary interventions, gastrostomies and other enteral feeding services, critical lower limb ischemia, urgent dialysis access interventions, central lines insertion and drains services.

Since the outset and during the lock-down, and over the period of 21 weeks, 680 patients were admitted through our RDCU.

Our main aim was to minimize the risk of COVID-19 cross-contamination. Before the admission, all patients are contacted to ensure they have no symptoms or contact with infected people. On the day of admission, all patients are triaged for temperature and symptoms in the reception area before being admitted to the unit. During and after the procedure, it was pivotal to separate these vulnerable patients from the potentially infected inpatient. Therefore, having the RDCU within the same unit as IR theatres ensured that these patients are transferred directly from the theatres to RDCU after the procedure and recovered there, while inpatients are recovered in our IR recovery. This ensured separate pathways for RDCU patients and inpatients. This reassured patients contemplating attending the hospital during the pandemic.

As the peak of the first wave of COVID-19 is subsiding, and while the lock-down is easing, having an RDCU has help us catch up with the elective backlog and maximised our throughput without competing with other specialties for beds. We are prioritising the patients according to clinical needs.During the ramp up of IR services, our pathways and protocols to ensure patient safety have been evolving constantly. We moved from routinely screening all elective patients within 72 hours of the procedure and 2 weeks isolation of the patients prior to admission, to advising the patient and their household to adhere to social distancing guidelines 2 week before

the procedure. Urgent cases are exempted from these guidelines, and they are individually risk assessed. Throughout the pandemic, our Radiology day case unit has been a cornerstone for sustaining our Interventional Radiology services, accommodating the increased demands for IR service, preventing patients’ acute admissions by treating them as outpatients, and now it is facilitating catching up with the large waiting list for the less urgent patients. This is proving that a Radiology Day Case Unit is essential for a sustainable IR service model.

Dr Mona Mossad, Consultant Interventional Radiologist and Interventional Oncology Lead University Hospitals of North Midlands