Overall Impact of the COVID-19 Pandemic on Interventional Radiology Services: A Canadian Perspective

Abstract

Purpose: The aim of this national survey was to assess the overall impact of the coronavirus disease 2019 (COVID-19) pandemic on the provision of interventional radiology (IR) services in Canada. Methods: An anonymous electronic survey was distributed via national and regional radiology societies, exploring (1) center information and staffing, (2) acute and on-call IR services, (3) elective IR services, (4) IR clinics, (5) multidisciplinary rounds, (6) IR training, (7) personal protection equipment (PPE), and departmental logistics. Results: Individual responses were received from 142 interventional radiologists across Canada (estimated 70% response rate). Nearly half of the participants (49.3%) reported an overall decrease in demand for acute IR services; on-call services were maintained at centers that routinely provide these services (99%). The majority of respondents (73.2%) were performing inpatient IR procedures at the bedside where possible. Most participants (88%) reported an overall decrease in elective IR services. Interventional radiology clinics and multidisciplinary rounds were predominately transitioned to virtual platforms. The vast majority of participants (93.7%) reported their center had disseminated an IR specific PPE policy; 73% reported a decrease in case volume for trainees by at least 25% and a proportion of trainees will either have a delay in starting their careers as IR attendings (24%) or fellowship training (35%). Conclusion: The COVID-19 pandemic has had a profound impact on IR services in Canada, particularly for elective cases. Many centers have utilized virtual platforms to provide multidisciplinary meetings, IR clinics, and training. Guidelines should be followed to ensure patient and staff safety while resuming IR services.

Impact of the COVID-19 pandemic on interventional radiology services across the world

“…Other IR clinical activities, most notably outpatient clinics and multidisciplinary meetings (MDMs), were also affected with three studies describing the adoption of virtual consultation and meetings to minimise exposure and provide continuous care. 14,15 Redeployment was detailed in three studies focusing on different staff groups including IR fellows, 16 allied healthcare professionals, 13 and all imaging staff, 17 and this ranged from 16 to 56% depending on local demand. Other changes in staffing included creating intensive care unit (ICU)-based IR teams to offer local support, 13 changing normal day-today practice to allow 24/7 service to continue, 9,11 splitting into two or more teams working on alternate weeks to ensure that if one team becomes infected there is a backup team.…”

“…Other changes in staffing included creating intensive care unit (ICU)-based IR teams to offer local support, 13 changing normal day-today practice to allow 24/7 service to continue, 9,11 splitting into two or more teams working on alternate weeks to ensure that if one team becomes infected there is a backup team. 15 The impact on IR training was assessed in four studies with case volume reduction for the trainees ranging from 11e51.9%, 14e16 whereas in one study all IR trainees were redeployed to ICU. 12 As compensation for the reduction in practical training, many centres reported increasing the number of online teaching sessions.…”

“…9,14 In addition to case volume reduction parallel to the overall service reduction, trainees also faced other issues such as examination cancellations post cancellation, and job deferral which have future implications. 15,16 No studies provided quantitative data on the reduced opportunities for medical students or juniors doctors prior to IR training. Similarly, no studies provided quantified data on strategies used to counteract the impact on training, e.g., virtual tutorials/conferences, practical skills simulation, etc.…”

“…The literature also demonstrated a comparatively lower reduction in IR volumes compared to many diagnostic radiology subspecialties/modalities. 3,17 With regards to urgent IR procedures, the UK and Canadian national surveys 9,15 showed a high proportion of departments experiencing volume reduction. Zhong et al 10 presented interesting data from six UK centres showing three experiencing a 38e145% increase, the other three a 25e80% decrease, and overall, a 0.5% caseload reduction.…”

“…For those who remained in IR services, rotas were restructured to allow for the increased sickness leave, for example, by splitting personnel up into multiple teams. 15 Operational changes included implementing enhanced cleaning protocols, designating COVID-19 rooms and optimising patient flow in the department to take into account social distancing and infection control measures. 7,8 Overall, proactive re-organisation of IR services has allowed continuation of essential IR services as well as supporting critical care.…”