Radiology departments as COVID-19 entry-door might improve healthcare efficacy and efficiency, and emergency department safety.

ABSTRACT

BACKGROUND: Possible COVID-19 pneumonia patients (ppCOVID-19) generally overwhelmed emergency departments (EDs) during the first COVID-19 wave. Home-confinement and primary-care phone follow-up was the first-level regional policy for preventing EDs to collapse. But when X-rays were needed, the traditional outpatient workflow at the radiology department was inefficient and potential interpersonal infections were of concern. We aimed to assess the efficiency of a primary-care high-resolution radiology service (pcHRRS) for ppCOVID-19 in terms of time at hospital and decision's reliability. METHODS: We assessed 849 consecutive ppCOVID-19 patients, 418 through the pcHRRS (home-confined ppCOVID-19 with negative-group 1- and positive-group 2-X-rays) and 431 arriving with respiratory symptoms to the ED by themselves (group 3). The pcHRRS provided X-rays and oximetry in an only-one-patient agenda. Radiologists made next-step decisions (group 1 pneumonia negative, home-confinement follow-up; group 2 pneumonia positive, ED assessment) according to X-ray results. We used ANOVA and Bonferroni correction, Student T, Chi2 tests to analyse changes in the ED workload, time-to-decision differences between groups, potential delays in patients acceding through the ED, and pcHRRS performance for deciding admission. RESULTS: The pcHRRS halved ED respiratory patients (49.2%), allowed faster decisions (group 1 vs. home-discharged group 2 and group 3 patients 041 ± 105 h; 336 ± 258 h; 350 ± 316 h; group 1 vs. all group 2 and group 3 patients 041 ± 105 h; 5.25 ± 3.08; 536 ± 436 h; group 2 vs. group 3 admitted patients 527 ± 308 h vs. 742 ± 502 h; all p < 0.001) and prompted admission (84/93, 90.3%) while maintaining time response for ED patients. CONCLUSIONS: Our pcHRRS may be a more efficient entry-door for ppCOVID-19 by decreasing ED patients and making expedited decisions while guaranteeing social distance.