Unless you live under a rock, your life and routine has been affected someway due to COVID-19.  Around the nation, we see closed schools, heart-breaking job loss, social distancing, and empty grocery shelves (what’s up with the toilet paper run!!).  While many people worry about losing their jobs and the financial implications, healthcare workers worry about their exposure to the virus and the health implications to self and loved ones.  This article addresses ways to keep ourselves safe based upon the recommendations as of March 28, 2020.  Always follow state and local recommendations.  Review the latest updates by the CDC and/or the WHO.

Who, Where, How?

Recommendations from the American Society of Echo (ASE), focus on the ‘who, where and how’ of performing echocardiograms during the COVID 19 outbreak.

Who needs an echo?

The short answer is to only scan patients whose exams yield clinically meaningful information.  For example, will the findings of the echo change the management of the patient?  Depending on the increased volume of echo orders, you may need to establish a triage system to prioritize which echocardiograms to perform first.

Who should reschedule?

• All elective exams. 
  • For example, pre-op studies with canceled surgery/procedures
  • Annual exams (yes, I know in theory these should not exist but…..)
• Reschedule all exams that do not change the treatment plan of the patient

When canceling/rescheduling an exam, be sure:

• There is “no significant risk to the patient in terms of morbidity or mortality” (ASE, 2020)
• That if by rescheduling the exam you are not increasing the chance that the patient ends up in the ER/re-hospitalization, as this would be a drain on much-needed hospital resources

Who should perform the echo? 

Sonographer Safety During COVID-19 Coronavirus:  As sonographers, physicians, and clinicians, we all have a responsibility to care for our patients.  But it is also essential that we protect ourselves, family, and loved ones.  How do we balance patient care and self-care during the coronavirus (COVID-19) pandemic?  Follow standard precautions for infection control and Personal Protection Equipment (PPE) recommendations.  Preferably sonographers that have been fit-tested for N95 masks should be the first option.  Limit staff participation – use only essential staff (no students, etc.)

Consider limiting exposure to at-risk staff members:

• Over 60
• Pregnant
• Immuno-deficient

Staying safe during the coronavirus pandemic

We should all be doing everything we can to help reduce the transmission of the coronavirus (COVID19) between patients, staff, departments, and inevitably our communities.  This makes echo triage critical to ensure that echocardiograms are only performed when it will make an immediate change to patient management. In regards to sonographer safety during COVID-19 Coronavirus remember:

• Patients with COVID19 present with signs and symptoms warranting an echo
• Ultrasound imaging requires face to face exposure throughout the entire testing procedure – unlike other imaging (CT, XRAY, MRI, etc.)
• TRIAGE EXAMS – Can the study be deferred?
  • Limit unnecessary testing which limits the need for PPE. There is a worldwide shortage of personal protective equipment (PPE).  (Masks, etc.)
• Ultrasound testing cannot be performed by non-trained personnel. 
• Most facilities have only a small number of echo techs compared with the large number of nurses and auxiliary staff.  We need to keep sonographers well and their colleagues out of isolation!

Summary

When it comes to sonographer safety during COVID-19 coronavirus it is vital to triage patients and only scan patients whose exams yield clinically meaningful information. Reschedule/defer all elective and non-urgent exams.

We will discuss amended scanning protocols, special precautions for TEE, best scanning locations, etc., in future blogs.

Resources

American Society of Echocardiography. (March 2020). ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak. https://www.asecho.org/covid-19-resources/

British Society of Echocardiography. (March 27, 2020). Clinical guidance regarding provisions of echocardiography during the COVID-19 pandemic

Sitammagari, K., Skandhan, A., & Dahlin, A. (March 11, 2020). What Hospitalists Need to Know About COVID-19. Medscape.