key: cord-0899263-ag4ved5o authors: Cahalane, Alexis M.; Cui, Jie; Sheridan, Robert M.; Thabet, Ashraf; Sutphin, Patrick D.; Palmer, William E.; Hirsh, Joshua A.; Kalva, Sanjeeva P. title: Changes in Interventional Radiology Practice in a Tertiary Academic Center in the United States during the COVID-19 Pandemic date: 2020-05-16 journal: J Am Coll Radiol DOI: 10.1016/j.jacr.2020.05.005 sha: a02255f1bc23b4d88c87e45c1f237b278b60e81b doc_id: 899263 cord_uid: ag4ved5o nan The clinical disease of severe acute respiratory syndrome coronavirus 2 was first reported in Wuhan in China in December 2019 [1] . Since then, there have been more than 1,171,000 confirmed cases and 68,000 deaths in the United States as of 5 May 2020 [2] . In order to mitigate the spread of the disease, the Governor of the Commonwealth of Massachusetts issued a "social distancing" order on 23 March [3] and the MA Department of Public Health issued a 'Stay-at-Home" advisory on 24 March 2020 [4] . In this context, hospital networks implemented significant changes in practice and workflow, particularly amongst procedure-based specialties, to facilitate the anticipated surge in COVID-19-related hospital admissions. This report describes the changes in workflow, caseload, procedure prioritization and staff deployment in a tertiary medical center during the COVID-19 pandemic. Elective surgeries and procedures have been postponed since 16 March 2020 to free up operation rooms (ORs) and associated staff for intensive care unit (ICU) bed conversion and to enable possible future redeployment respectively [5] . To prepare for the anticipated COVID-19 surge, the IR administration evaluated all procedures scheduled after 16 March 2020 and categorized each procedure as "Emergent/Urgent", "Case-by-Case", and "Elective" with nearly all elective procedures postponed (Table 1 ). In addition, every procedure request was first evaluated for outpatient IR suite eligibility to decrease patients' risks of hospital exposure. IR attendings were assigned to a new ICU-based team to provide bedside venous access options for COVID-19 patients, while a more formalized ambulatory team of an IR trainee and attending was created to perform routine bedside procedures including US-guided paracentesis, thoracentesis or drainages in suitable COVID-19 positive and negative patients to minimize patient transfer to reduce the risks of transmission during transportation. IR nursing and technologist staffing levels during this period were reviewed to ensure compatibility with staffing requirements elsewhere in the hospital. All IR procedures performed in our division during the first 4 weeks of the COVID-19 pandemic (03/16/2020-04/17/2020) were identified and analyzed, before being compared with a similar four week period in 2019 (03/18/2019-04/19/2019). The number of IR procedures performed during the COVID-19 pandemic decreased from 1710 to 919 in the comparable period in 2019, constituting a 46% reduction. Figure 1A ). The reduction in CT-guided procedure caseload (56.6%) was the largest during the COVID-19 pandemic when compared to FL-guided (42.5%) and US-guided (48.4%) procedures. In 2019, inpatient procedures accounted for 42.3% of all IR procedures, compared to 41.3% during the COVID-19 pandemic. Among all inpatient procedures, CT-guided procedures experienced the greatest reduction (127 vs 56, 56%), followed by US- Among CT-guided procedures, there was a 90% reduction in bone/central nervous system (CNS) related procedures (10 v 1). The number of gastrostomy/jejunostomy tube placements decreased by 89% (9 v 1). This compared to a 61.5% decrease in The number of cases performed on the main campus and outpatient IR suites were analyzed and compared (Figure 2A) . Only cases performed on weekdays were included to allow a more accurate comparison as the outpatient IR suite did not operate on weekends. On the main hospital campus, the average number of IR procedures performed per weekday decreased by 56.7% during the first four weeks of the COVID-19 pandemic (72.7 v 31.6). In comparison, average procedures performed at the outpatient IR suite per weekday increased by 23.4% during the pandemic (5.6 v 6.9) ( Figure 2B and 2C) . This report details the impact of COVID-19 on an IR division in a tertiary academic medical center during the COVID-19 pandemic, which may provide insights and information to other centers located in COVID-19 epicenters. The fall in cases within IR likely mirrors the significant changes in work patterns and caseloads across multiple specialties, something that has already been reflected in preliminary studies published elsewhere [6] . As the pandemic continues, we plan to continue to follow this early signal and re-allocate our resources to areas that require most urgent support. It is particularly crucial to meet patients' needs given the decreased IR resources during the COVID-19 pandemic. SARS-CoV-2 is an appropriate name for the new coronavirus Coronavirus Disease 2019 (COVID-19) Cases in the U.S. In: National Center for Immunization and Respiratory Diseases (NCIRD) DoVD Order assuring continued operation of essential services in the commonwealth, closing certain workplaces, and prohibiting gatherings of more than 10 people DPH Public Health Advisory: Stay-at-Home Advisory Rapid Response of an Academic Surgical Department to the COVID-19 Pandemic: Implications for Patients, Surgeons, and the Community Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States during COVID-19 Pandemic