Singapore’s Hands-Off COVID-19 Approach

April 22, 2020
Whitney J. Palmer

Signapore General Hospital's “touch-me-not” policies for staff and patients.

When it comes to social distancing in radiology, your first thought might jump directly to teleradiology. And, you’d largely be right – many providers are working, reading, and submitting structured reports from home. But, not every office or department has the resources for home-based work stations. So, successful social – and safe – distancing can require a few more steps.

Singapore General Hospital and Duke-NUS Medical School have taken a much broader approach to the distancing necessary to curtail the spread of COVID-19. In an article published this week in the Journal of the American College of Radiology, members of the radiology department detailed the multiple steps they followed to keep both providers and patients safe.

“We, as radiology services, have our own unique role to play during this pandemic,” wrote the team, led by Robert Chun Chen, M.D. “Our experience over the last 11 weeks may help others do their part in flattening the curve, allowing us, as a community, to remain safe and emerge re-vitalized and stronger than before.”

To meet that goal, the team outlined several strategies implemented for both staff and patients that have help reduce viral transmission.

Staff Changes

Due to infrastructure difficulties, the team wrote, teleradiology wasn’t a workable solution for the hospital. They had to devise other protective tactics for their more than 600-person radiology workforce that includes providers, technologists, and nurses.

Group work: To meet care needs, they divided into three groups. Each cohort, one serving inpatients and two serving outpatients, included body, musculoskeletal, and neuroradiology sub-specialists, and they rotate environments monthly. They further minimized daily interactions by planning 15-minutes between shift changes. For example, one shift ends at 5:45 p.m., and the next round of providers doesn't arrive until 6 p.m.

Communication: The team also reported the department has implemented several new protocols that maximize physical distancing. Staff must wear masks at all times, and all in-person verbal conversations must take place at least 1 meter apart. Referring clinicians are being routed to consultations via phone or HIPAA-compliant message platforms, and for other essential meetings, providers are using tele-conferencing applications. If an in-person meeting is unavoidable, the team wrote, all attendees wear masks and are separated by 1 meter to 2 meters.

Meals: Once considered a time for socializing and team-building, the department recognizes that sitting together at a table currently is a prime opportunity for unintended infection. Now, staff bring bag lunches from home and eat in designated areas with their work group. During meals, they sit at least 1 meter apart, keep conversation to a mininum, and limit dining time to 30 minutes. The hospital has also opened up additional areas to control the number of staff eating in the same location at the same time.

A Streamlined Patient Strategy

Prior publications have discussed physical distancing and appointment spacing measures for patients in the radiology department. Singapore, however, is enhancing this effort, exploring a new model, called the “Precision Appointment” (PrApp) model to streamline patient services in an effort to minimize infection.

This model was borne out of a project in the department, called Future Radiological Sciences Patient Journey, that was crafted in preparation for a new hospital complex. Through real-time communication, the department can know – almost down to the minute – when a patient will arrive for a scan.

“With these accurate appointment times, [patients are able] to walk in, get scanned, and leave the department with zero-to-minimal dwell time in the department,” the team wrote.

Changes & Benefits of Technology-Based Connectedness

Maintaining a physical distance has made it harder for attending providers to instruct and guide trainees, the team said. Without the ability to work side-by-side, attendings are making concerted efforts to reach out to trainees over the phone to offer feedback and encouragement.

And, with the extra stresses on resources and time, staff morale and mental well-being can be more fragile. Hospital administration should be cognizant of the added pressures on frontline workers, they said.

“Simple words of encouragement from hospital leadership, disseminated by email or other means, cannot be underestimated to boost team morale,” they wrote.

Human resource officers should also consider creating a gratitude program, they suggested. For example, staff in Singapore General receive gift bags with bottles of hand sanitizers, energy bars, and hand-written notes of appreciation from patients and members of the public.

But, not every impact of the COVID-19 pandemic has been a negative one on day-to-day work, they said. The increase in technological connectivity between departments and groups has created a new social network.

“A new virtual connectedness is emerging,” they wrote. “Previous disparate groups are now connected via new community chat groups that cross sub-specialty teams barriers. The number of communications on these chat groups has multiplied, allowing participants to share information, raise questions, and empathize with others.”

As a department dedicated to providing the imaging scans patients need during this pandemic, the team acknowledges that social distancing is only one arrow in the quiver as efforts to control the virus continue. But, measure to maximize physical distancing are critical, as is the message to abide by them.

“Safe distancing measure must be in sync with institutional and national policies, such that all hospital staff and patients are receiving a clear and consistent message,” they wrote. “And, these policies must be packaged as a new normative state, ingrained within all our DNA.”