Standard Operating Procedure Nuclear Medicine During the ... · The risk of infection outweighs the need for outpatient imaging in all but the most urgent cases. This document details

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




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




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.




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.





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.


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




10. DOCUMENT HISTORY/REVIEW

Document Name


Current Filename SOP-BSUH-Imag-CV19-002

Issue Date Review Details

1 06/04/2020 1st Issue

2

3

4

5

6




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




Appendix 2

Summary flow chart (Nuclear Medicine) COVID-19 crisis




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




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