Escalation and de-escalation of the radiology response to COVID-19 in a tertiary hospital in South London: The King’s College Hospital experience

Abstract

The pandemic of COVID-19 presented an enormous challenge to the medical world in terms of diagnosis, treatment and health-care management as well as service organisation and provision. This novel virus and its spread affected every aspect of modern medical practice, ranging from investigating transmission of this new pathogen, antigen testing of symptomatic patients, imaging, assessing different treatment regimens and the production of a new vaccine. Imaging played a crucial role in the diagnosis of COVID-19-related lung disease, with plain radiography and CT being the main diagnostic modalities, with ultrasound a useful bedside imaging tool. The accurate and early diagnosis of the disease was not the only issue faced by Radiology Departments across the world; prevention of nosocomial infection, creating capacity with elective imaging suspension, management and protection of the workforce being few of the numerous challenges. The purpose of this manuscript is to present the steps that the Radiology Department of a large urban tertiary facility with a local vulnerable population, undertook to adapt the imaging service and structure, both initially escalating and then de-escalating a response to the COVID-19 pandemic. A step-by-step management strategy, effective and sustained staff deployment, imaging management are presented and discussed, to provide a guide for managing a major incident in a radiology department.

A systematic review of de-escalation strategies for redeployed staff and repurposed facilities in COVID-19 intensive care units (ICUs) during the pandemic

“…A summary of the key characteristics of the included papers can be found in Table 2 . Of the 15 papers included, two were based on empirical data, ten were based on data from case studies, commentary articles or letters to the editor, 16 , 17 , 18 , 19 , 20 , 21 , 22 , 24 , 29 and three were guidelines on how to manage the de-escalation of ICUs. 25 , 26 , 28 The included papers were from the UK ( n = 6), the USA ( n = 4), Singapore ( n = 2), China ( n = 1), Iran ( n = 1), and Australia ( n = 1).…”

“… 17 Case study NYU Langone-Brooklyn Hospital, New York, USA Neurology staff Operational strategies for workforce and facilities AACODS: 5.5/6 Panayiotou et al. 18 Case study Kings College Hospital, London, UK Radiologist trainees Training, wellbeing, and operational strategies for workforce AACODS: 5.5/6 Doyle et al. 20 Case study John Radcliffe Hospital, Oxford, UK Medical staff Operational strategies for workforce AACODS: 5.5/6 Lum et al.…”

“…A common strategy implemented to improve the wellbeing of the returning redeployed staff was to provide time off to rest and recuperate. 18 , 23 , 26 , 27 , 28 Leng et al. 27 shared that following the redeployment period, the nurses received a three week holiday and Panayiotou et al.…”

“… 27 shared that following the redeployment period, the nurses received a three week holiday and Panayiotou et al. 18 shared a similar experience that returning trainees were encouraged to take vacation leave. Poortaghi et al.…”

“…15 With the decline in ICU patients, many of the redeployed workforce and temporary ICUs could return to usual functions, and numerous publications have documented how these processes have occurred in different hospital settings. 8 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Since the initial decline, many countries have faced recuring waves of COVID-19 infections and ICU admissions. 15 This repetitive surge in need for ICU capacity followed by de-escalation is likely to continue for some time whilst variants of SARS-CoV-2 continue to circulate throughout the globe.…”