As health systems begin ramping back up on typical procedures, imaging department leaders are facing—or will face—three pressing challenges:
1. Large and growing backlog of exams
Many systems are currently in a situation where 60-70% of imaging volumes dropped away for multiple months. Imaging departments will face challenges “catching up” on these exams, much less keeping up with new, incoming orders. This means that access will be a major challenge for months, and systems could experience delays in patient care and potential leakage of volumes outside of the system.
2. Slower turnaround times
Improving efficiency and speeding turnaround times has been a focus for imaging department leaders for years. However, the post-Covid world is going to be very different, and imaging is no exception. Staff and patient safety, always a priority, has taken on a whole new meaning. Cleaning, sanitizing, and following infection protocols should be the biggest focus of imaging programs, but they will have an adverse effect on throughput.
In the long run, widespread testing will allow programs to test every patient before their exam and reduce the need for cleaning. However, we do not anticipate that imaging programs will have access to enough tests in the coming months to implement such a system. Therefore, in the short term, we expect that the additional cleaning between exams will likely add 10-20 minutes to each slot time.
3. Tightening margins
Hospitals and health systems are struggling financially as a result of the cancellation of the majority of elective procedures. They will be looking to ramp up procedures and other services as quickly as possible to start generating revenue. Because many of these revenue-generating procedures occur downstream of imaging, the imaging department is going to face early pressure to ramp up quickly. However, with reduced throughput, imaging may not be able to quickly move through the patient backlog. Additionally, this reduced capacity will only further impact revenue, as imaging centers may become a cost center as opposed to a revenue center for hospitals.
Four solutions imaging departments should consider
To serve patients and larger system goals, imaging departments will have to do everything they can to move through the backlog quickly. There is no easy answer here, but there are a few potential solutions that most, if not all, imaging departments should be considering. Below we briefly discuss four of these solutions along with guidance on which departments these will be most useful for.
All imaging departments
1. Extend hours
The combination of decreased throughput and significant backlog means every program is going to have to consider extending hours. However, programs should not blindly extend hours across all modalities and locations—operating additional hours without filling the schedule will increase costs. They should instead identify modalities with the highest backlog and only extend hours for those modalities. Furthermore, programs should be flexible in hours as much as possible, as weekly volumes may vary.
2. Cross-train technologists
While most organizations have some level of cross-training already in place, we believe most programs will benefit from having more cross-trained technologists in the post-Covid ramp-up. As discussed above, most imaging departments can and should extend hours. It will be easier to staff these new hours if the workforce is cross-trained. Increased cross training can help limit overtime if hours are extended for certain modalities. Fortunately, with outpatient volumes still well below normal, staff will have the time to go through training now.
Large systems with multiple sites
3. Flex staff across sites appropriately
For larger systems with multiple outpatient centers, the ability to shift staff from site-to-site or from inpatient to outpatient as necessary will become more important going forward. While we believe that imaging programs should prioritize developing a more flexible workforce, leaders should be aware that flexing staff could increase the potential impact of a staff member becoming infected. If a staff member is infected and has worked at multiple sites, this could double or even triple the amount of quarantined staff and cleaning that must be done. Until programs can test staff regularly, they should consider a pod or team system to limit the negative impact of a team member becoming infected.
Systems facing staffing shortages and/or increased financial burden due to staffing costs
4. Adjust staffing structure
Leaders should recognize that old staffing models may not fit the extended slot times and reduced throughput that will come from social distancing requirements and sanitation protocols. If programs scan a reduced number of patients per hour, they can adjust their staffing to match. For instance, some programs might be able to decrease the number of technologists and increase the number of technologist aides they staff at any one time. These tech aides can take the additional cleaning requirements, allowing the technologists to work top of license. And with less patients per hour, programs may be able to staff less of those technologists at any given time.
Over the coming weeks and months, Covid-19 will force imaging programs to adapt to tighter margins and reduced access and throughput. Imaging leaders that think creatively about staffing, scheduling, and capacity management will be better able to support their organizations overall recovery.
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