COVID-19: Statement on Health Services

March 16, 2020

Health Minister Christine Elliott released a statement yesterday about elective surgeries and other non-emergent clinical activity in hospitals intended to carefully consider how to best maximize resources and prioritize services. There was no mention of many other health care facilities like radiology IHFs.

The province is requesting that all hospitals further implement pandemic plans by carefully ramping down elective surgeries and other non-emergent clinical activity.

The MOH is asking that hospitals and other major providers like IHFs to follow three guiding principles:

Use an ethical framework to guide decision-making;
Prevent high risk and occult transmission; and
Develop and preserve capacity within our system.

OAR Urgently Seeks Radiologists' Input for DI COVID-19 Plan

The OAR is seeking urgent input from both Ontario hospital and IHF radiologists to devise a uniform province-wide approach for each practice setting with respect to DI services taking into consideration the Health Minister’s statement and how a “ramping down of elective services” should be implemented: staged or immediately. If staged, what recommendations do you have with respect to what should be included in an orderly reduction of normal elective service levels in imaging so that a uniform approach can be recommended for radiologists to follow across the province. The CAR has just issued a statement recommending immediate discontinuation of breast imaging services for the next 6-8 weeks (see link).

The Health Minister’s statement understandably focusses on elective surgical procedures and non-emergent clinical activity without offering much in the way of specific direction for major medical programs like DI that is playing a central role in the diagnosis of COVID-19 patients as well as maintaining the delivering of essential medical imaging services affecting many critical health programs already affected by growing wait lists. The statement is silent on recommended actions for IHFs and many other health care provider facilities.

Seeking Clarification about Radiology IHFs

The solitary focus on hospitals makes no mention of how 50% of Ontario’s outpatient imaging activity should be handled in IHF clinics where many affected patients may first appear for care as occurred during the SARS episode. The OAR is seeking IHF Radiologist input to develop a coordinated response that is reflective of the demands on IHFs while responding to the Ontario Chief Medical Officer of Health’s appeal to the medical community. See the link that was sent out last week regarding some provisional information that related to recommended actions to be taken in IHFs (see link).

OAR Addressing the Issues

Radiologists working remotely instead of physically located at hospitals and clinics
Availability of protective gear for DI staff
Procedures vetting DI patients suspected of having or at risk of having COVID-19
Supports for DI operations during this unsettled period

The OMA has issued a communication to Ontario physicians recommending the use of new physician billing codes for telephone assessments, which has limited application to DI. What relevant DI recommendations do you suggest we raise with health authorities?

OAR Urgently Seeks Radiologists' Input for DI COVID-19 Plan

The OAR is taking the following actions:

Seeking direction and clarification on actions to be taken by IHFs
Seeking broad radiologist input to ensure a bottom-up approach to our actions and recommendations to members for hospitals and IHFs
Communicating with the MOH and the OMA regarding issues raised by our members to seek answers and provide recommendations for action and other supports to assist and protect our patients, staff and colleagues during this period of great unknown.
The OAR will be issuing more communications as information specific to our specialty become known
The OAR is also drawing on experiences from SARS. Many of the actions that occurred at that time happened in the later stages of that crisis and need to be accelerated into action now with COVID-19.

Refer to the ACR COVID-19 Radiology-Specific Resources communication here.

Forward your comments ASAP, advice and any relevant literature/guidelines to the OAR at mail@oarinfo.ca