Enhancing MR Suite Efficiency During the Pandemic

Washington state reported the first confirmed COVID-19 case in the United States on January 20, 2020. In the months that followed, the Seattle area became the epicenter of the nation’s outbreak. The University of Washington Medical Center (UWMC) has been on the leading edge of addressing the COVID-19 crisis from the beginning.

Mahmud Mossa-Basha, MD, a diagnostic neuroradiologist at UWMC, has been integral to this response, helping the MR suite adjust to pandemic-related changes. Dr. Mossa-Basha serves as the vice chair of clinical operations for the radiology department and the medical director for MR. 

In the last two years, he’s served as the chair for the RSNA COVID Taskforce, where he directed his efforts to recommending operational changes within radiology departments and providing national guidelines that were published on the RSNA website. These included a number of topics such as elective imaging postponement, hygiene practices, best practices for equipment cleaning, healthcare worker personal protective equipment for procedure and imaging scenarios, donning and doffing of personal protective equipment, and workflow and safety for imaging of COVID or suspected COVID patients.

UWMC has a fleet of more than 15 MR scanners located at more than a half-dozen facilities throughout Seattle. About 70 percent of MR studies are neurological, with the rest making up body, cardiac, and musculoskeletal (MSK) imaging.

During the initial COVID shutdown from March through May 2020, MR volume at UWMC dropped 40 percent to 60 percent, depending on clinic location, resulting in a significant financial blow. Upon reopening, MR volume slowly rebounded to pre-pandemic levels and has since grown 10 percent to 15 percent above pre-pandemic volumes.  “Now, with some of the initiatives we've taken on, our volumes are higher than they've ever been,” says Dr. Mossa-Basha.

Shorter Scan Times

To alleviate patient volume challenges, UWMC has implemented several technologies to shorten scan times. For example, artificial intelligence-based imaging reconstruction, compressed sensing, and 32-channel head coils enable UWMC to reduce brain MR scanning from approximately 25 minutes to eight minutes.

“When COVID hit, it was an opportunity for us to re-evaluate the imaging that we were doing. We leaned into imaging acceleration techniques to speed up our scans,” he explains. “COVID provided us with an opportunity to improve our operational efficiencies and workflows, out of necessity. It put everyone into action.”

Spine, body, liver, and other studies also became shorter. Dr. Mossa-Basha estimates liver scan duration has been cut in half by reducing sequences and streamlining the imaging to focus on necessary valuable sequences.

“Across the board, we've taken steps to improve our imaging speed, as well as our image quality,” he says. “The efficiency gains we have experienced in MR are here to stay, because in the end, those are net benefits, in terms of patient experience, access, and department fiscal health.”

Updated Scheduling and Increased Staffing

Better scheduling starts with properly assessing the time needed for patient preparation, and then standardizing processes to streamline workflows and patient management.

Prior to the pandemic, scheduling could be inaccurate, with patients scheduled for 30- or 40-minute blocks for a scan that needed an hour. “Now we make sure that the schedule actually matches the scan times, and there's enough time to facilitate an on-time schedule,” Dr. Mossa-Basha says.

Indeed, since reopening its clinics after shutdown, UWMC schedules neuro scans in 15-minute blocks to accommodate growing patient loads and new cleaning and disinfection protocols, which include testing patients for COVID infection and symptoms. Dr. Mossa-Basha has also recently added two nurses, two technologists and one MR assistant to the department to further maximize efficiency for the four MR scanners at UWMC-Montlake campus.

“We've built in gaps between every MR scan, which allows time to go in and clean the scanning room. Usually, it's either a technologist or an MR assistant who will clean the equipment after every scan and every patient,” Dr. Mossa-Basha says.

The new protocols especially help with intubated COVID patients who need brain studies for strokes and other neurological illnesses. These exams can take up to five hours. Intubated patients are mostly in-patients, and they are scheduled for late in the day, which not only adheres to air exchange safety and precaution protocols, but also supports an easier transition to the next day.

“Imaging COVID patients is an aerosol procedure because of intubation. That can gum up the system because it requires a lot of processes and steps in terms of protection, air exchange, and patient preparation,” he says.

Workflow Improvements

The medical center created outposts throughout its hospitals and clinics, where radiologists can remotely read in a safe environment. Work-from-home opportunities were also instituted.

“A lot of the outpatient centers had reading rooms that were under-utilized. We converted rooms in those centers as makeshift reading rooms, which provided isolated space for radiologists to read studies,” he says, noting that previous upgrades to the IT network facilitated the transition.

“Years before COVID, we went through some big IT projects to make sure that our PACS and EMR were integrated across all sites, and all systems were standardized. We were very fortunate that we did that because once we came to the pandemic, we were ready for it,” he says.

However, working from home posed a new challenge that necessitated additional improvements. “We had to accelerate that progress during the pandemic by creating a very responsive PACS, EMR, RIS, and dictation system through remote virtual desktops. This was very important for us,” he says.  Dr. Mossa-Basha expects to continue this established progress of efficiency and accuracy.

 The next thing we need to focus on is optimizing workflow efficiencies to improve interpretation turnaround time,” he says. “By incorporating AI and other smart technologies, we can make our reading more efficient, keep up with the volume and address the financial aspects, which will all be important.”