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Imaging (Nuclear Medicine) during the Covid-19 Pandemic
SOP-BSUH-Imag-CV19-002
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Standard Operating Procedure
Nuclear Medicine During the Covid-19 Pandemic: Postponement and Risk Stratification of Appointments
Refer also to following SOP(s) / Other Imaging Documents:
Refer to Risk Assessment: N/A
Refer to COSHH Assessment: N/A
Location(s): BSUH
Author: Guy Cooper, Nitasha Singh, Maryam Jessop
Issue No:1
Manager responsible (name): Katherine Day
Manager responsible (post): Imaging Service Manager
Approving Committee: Silver Command Committee
Date of Approval: 9th April 2020
Issue Date: 6th April 2020 Review date: October 2020
Imaging (Nuclear Medicine) during the Covid-19 Pandemic
SOP-BSUH-Imag-CV19-002
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INDEX
1. INTRODUCTION 2. READERSHIP
3. ROLES & RESPONSIBILITY
4. EQUIPMENT
5. HAZARDS and SAFETY and RADIATION PROTECTION
6. PROCEDURE / SYSTEMS IN PLACE
7. MONITORING & QUALITY CONTROL
8. DISSEMINATION
9. APPENDICES / RELATED DOCUMENTS
10. DOCUMENT HISTORY
Imaging (Nuclear Medicine) during the Covid-19 Pandemic
SOP-BSUH-Imag-CV19-002
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1. INTRODUCTION Ensuring the safety and best care of patients is our primary concern at all times. Given the impact of Covid-19, a pragmatic approach for the management of all imaging studies is required while it continues to affect our services. The usual diagnostic and treatment pathway will not be sustainable during this time, and imaging requests need to be rationalised to ensure resources are focused on the most clinically appropriate cases. We have to minimise outpatient attendance to reduce the COVID-19 risk to patients and hospital staff. The risk of infection outweighs the need for outpatient imaging in all but the most urgent cases. This document details the process for cancelling and postponing non-urgent imaging during the Covid-19 pandemic, and risk stratifying those cases that do require urgent imaging. We know that this strategy will have an impact on patients, but it is driven by the need to keep everyone safe while Covid-19 continues to affect clinical care. The strategy has a number of ‘safety nets’ to ensure patients who need urgent imaging get it in a timely manner.
2. READERSHIP
All Nuclear Medicine and Imaging Consultants and Registrars
Nuclear medicine technologists
Bookings team
Modality leads
Hospital consultants referring for imaging at BSUH
3. ROLES AND RESPONSIBILTIES
All Nuclear Medicine Consultants – take responsibility for vetting all scans (see guidance appendix 3) and respond to clinicians when a cancelled scan is contested. Vetting may be delegated to a Nuclear Medicine Registrar with appropriate support from the Consultants.
Technologist and admin teams – liaise with patients, Nuclear Medicine Consultants, referring Consultants and MDM co-ordinators where appropriate.
Referring clinicians review postponed appointments and inform the Nuclear Medicine department should any patients require imaging during the COVID-19 crisis.
4. EQUIPMENT CRIS vetting list and referral requests.
Imaging (Nuclear Medicine) during the Covid-19 Pandemic
SOP-BSUH-Imag-CV19-002
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5. HAZARDS and SAFETY and RADIATION PROTECTION
This SOP is to minimise unnecessary outpatient attendances to the hospital for the protection of patients, staff and the general population. Any patients cancelled due to COVID-19 must be cancelled using the ‘H-19’ CRIS code (see appendix 1 and vetting guidance for instructions).
6. PROCEDURE / SYSTEMS – see summary flow chart appendix 2
Routine imaging – nuclear medicine imaging requests coded 1 (routine), 5 (to be done in 2-4 weeks) and 8 (cancer pathway)
All imaging requests will be reviewed and justified by Nuclear Medicine Consultant or delegate Registrar and cancelled under H-19 CRIS code.
Letter of notification of postponed scan is sent to the referrer (appendix 4).
If the referrer would like any postponed or cancelled patient, scanned as urgent – they are to communicate with Nuclear Medicine. When rebooked, document in ‘event details’ that this is agreed.
The hospital number and name will be recorded in the relevant tab on a spreadsheet in the Nuclear medicine T-drive. T:\Nuclear Medicine\COVID-19\Postponement letters sent.
Patient cancelled due to COVID-19 (P-19)
Letter of notification of postponed scan is sent to the referrer.
New requests
Record any referrer comments relating to urgency in ‘event comments’ and with any related e-mail scanned into CRIS event.
Only Nuclear Medicine Consultant or delegate vetted scans will be performed during COVID-19 crisis. (See BNMS guidelines -appendix 3)
For all scans that are postponed at this time, a notification letter will be sent to the referrer.
The hospital number and name will be recorded in the relevant tab on a spreadsheet in the Nuclear medicine T-drive. T:\Nuclear Medicine\COVID-19\Postponement letters sent.
Imaging (Nuclear Medicine) during the Covid-19 Pandemic
SOP-BSUH-Imag-CV19-002
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Safety Nets
Scans postponed or cancelled must be noted on CRIS using the H-19 / P-19 CRIS codes. A notification letter or email will be sent to the referrer.
The hospital number and name will be recorded in the relevant tab on a spreadsheet in the Nuclear medicine T-drive. T:\Nuclear Medicine\COVID-19\Postponement letters sent.
If referring clinicians deem the imaging request should not be postponed and needs to happen urgently, referring clinician must liaise with Nuclear Medicine and reinstate the request for imaging if required.
Referrals from other Trusts or organisations will receive a letter from the nuclear medicine department for each patient that has had the imaging request cancelled.
7. MONITORING & QUALITY CONTROL
Developmental Outcome Measure
Monitoring Outcome Measure
Frequency Responsibility for performing monitoring
Where is monitoring reported and who will be responsible for progressing and reviewing action
8. DISSEMINATION
Insert hyperlink to Dissemination SOP (once available)
9. APPENDICES / RELATED DOCUMENTS
1. How to cancel appointments on CRIS
2. Summary flow chart (Nuclear Medicine) COVID-19 crisis 3. BNMS guidelines for rebooking tests 4. Postponement notification letter to referrers
Imaging (Nuclear Medicine) during the Covid-19 Pandemic
SOP-BSUH-Imag-CV19-002
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10. DOCUMENT HISTORY/REVIEW
Document Name
Imaging (Nuclear Medicine) during the Covid-19 Pandemic
Current Filename SOP-BSUH-Imag-CV19-002
Issue Date Review Details
1 06/04/2020 1st Issue
2
3
4
5
6
Imaging (Nuclear Medicine) during the Covid-19 Pandemic
SOP-BSUH-Imag-CV19-002
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Appendix 1
How to cancel appointments on CRIS
Go to appointments list selecting site room and modality and click list Select individual patient and review clinical details. In event details select cancel
Click and then select Hospital Covid Cancel
Imaging (Nuclear Medicine) during the Covid-19 Pandemic
SOP-BSUH-Imag-CV19-002
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Appendix 2
Summary flow chart (Nuclear Medicine) COVID-19 crisis
Imaging (Nuclear Medicine) during the Covid-19 Pandemic
SOP-BSUH-Imag-CV19-002
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Appendix 3: BNMS guidelines for rebooking tests Ref: COVID-19: Guidance for infection prevention and control in nuclear medicine (Information as of 26th March 2020)
Do not cancel or rebook unless patient at risk Book all new referrals
Discuss with clinician if there is a need to cancel/rebook New referrals to be discussed
Rebook without need for discussion with a clinician
Imaging (Nuclear Medicine) during the Covid-19 Pandemic
SOP-BSUH-Imag-CV19-002
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Appendix 4 Postponement notification letter to referrers
Nuclear Medicine Department Royal Sussex County Hospital Eastern Road Brighton 01273 696955 ext. 64382 [email protected] April 2020
Dear
Clinical Referrer
Referrer location
Re:
Patient name
dob
Hospital number
NHS number
Scan requested
Due to the current COVID-19 situation, unfortunately we have had to postpone all routine Nuclear
medicine imaging. These patient referrals will be reinstated once the crisis has settled, according to priority
of clinical urgency (as per information provided on the request form). We would be more than happy to
discuss any referrals you feel cannot wait for this longer period of time (ext. 64382/67618). Conversely, on
review of this patient, if you decide you no longer need the scan then please let us know by email above.
Urgent and essential oncology studies, however, will still be performed if clinically required during this time. Many thanks for your understanding. Nuclear Medicine Department Brighton and Sussex University Hospitals NHS Trust