The COVID-19 pandemic has delayed screenings for millions of patients, with breast cancer screenings in the United States declining by 94% in the month of March 2020 alone.
With this decline, tens of thousands of women have postponed their breast screenings and prolonged their uncertainty. It has also brought unprecedented challenges for women’s health practices worldwide.
In the U.S., many clinics are beginning to reopen, while others have remained open throughout the pandemic. Despite being in varying stages and managing different types of practices, providers are all working to get back to screening capacity by redefining workflows and enhancing the patient experience.
To learn from those managing this firsthand, GE Healthcare Insights spoke with several breast care experts about their experiences:
- Melissa Marx, Administrator, Fort Jesse Imaging & Gale Keeran Center for Women
- Dr. Gary Dee, President Midstate Radiology associates and Chairman of the Radiology Council Hartford Healthcare
- Dr. Angela Fried, Director of Breast Radiology, SimonMed Imaging
How has COVID-19 impacted your clinic?
Melissa Marx: “We saw the decline in patients as everyone did, so we acted very quickly to decide if we should stay open. Ultimately, we felt like we knew the local hospitals were going to discontinue screenings, so there was a place for us that was needed within our community. I knew we had to fight to stay open because patients still wanted to come in. As a result, we were able to keep 40% capacity and caught cancers in three asymptomatic women during the pandemic.”
Dr. Dee: “Our proximity to New York City caused us to be hit extremely hard. Our imaging volumes experienced about a 60% drop and our screening became almost zero. Despite the drop, we kept our office practice open with the help of the paycheck protection subsidy. This allowed us to take the burden of non-covered patients from the hospitals and to have a pool technologist to replace technologists who were sick within the hospital environment. We reopened for screening on May 4th.”
Dr. Fried: “Once we started having the lockdown, we had a significant drop in our screenings, but we continued to do a large amount of diagnostic imaging. We ended up having to furlough some of our radiologists and technologists and we closed multiple centers. We haven’t fully reopened yet, but we have restarted screening in the past couple weeks. Our volume is picking up, but it’s not near where we were the year before.”
What protocols are you putting in place in this new environment?
Melissa Marx: “We screen our patients on the phone before their appointment; we rescreen them when they check in; and all our staff’s temperatures are taken when they check in. We provide masks for all staff and patients. We’ve created new cleaning and sanitizing rotations, even the chairs they’re sitting on have been changed to plastic ones for easier cleaning. We installed barriers at our check in. We let patients know they must come by themselves and give them a pen to keep for any forms they must sign. We’ve heard great feedback from our patients so far, some have said they even felt safer at the clinic than a grocery store.”
Dr. Dee: “We re-engineered the waiting rooms, going from 15-16 chairs down to 4-5. We also developed a virtual waiting room via text messaging software, which has been extremely successful. Patients will stay in their car, and they’re texted when to come up for their procedure. All patients and staff have PPE. We have implemented new cleaning protocols and rented ultraviolet disinfection machines for each office. We decreased examinations from 4-5 an hour to 2-3 an hour, and because of this we had to expand our hours and days of operations. We’ve also rolled out YouTube™ videos so patients will know what to expect. This has all worked very successfully, as we’ve already seen our volumes go from almost nothing to 70% already.”
Dr. Fried: “One other protocol that Simon Med implemented that has been useful during this is having a large contingent of remote radiologists that perform diagnostic imaging who are used to doing this and to providing results over the phone. That was already in place before all of this happened and has helped us continue to do diagnostics during the shutdown.”
How have you managed patients who have had their breast screenings delayed and the growing backlog of missed screenings?
Melissa Marx: “We call every patient before their screening, because things are very different now than when they scheduled it a year ago. We have a mammo tech call them to let them know of our new cleaning procedures and what to expect when they come. If they’re still not comfortable with coming in, we flag them in our system with a COVID-19 flag. We can then run a report using that flag to get a list of patients we need to reschedule in June, July and August.”
Dr. Fried: “If you are having a backlog of patients and needing to determine who should be scheduled for return, I personally would look at those patients that are at higher risk, such as those with previous suspicious findings or those determined to have cancer and need follow-up procedures as part of the patient care pathway. For those patients returning, a workflow tool such as Profound AI may help with reading cases. Profound AI is a concurrent-read, cancer detection and workﬂow solution that rapidly analyzes each tomosynthesis image accurately, detecting both malignant soft tissue densities and calcifications and provides a Certainty of Finding and Case Scores. The Certainty of Finding and Case Scores serve as a guide to the interpreting radiologist to aid in determining if a suspicious finding or case needs further workup.“
Dr. Dee: “We are lucky in that we do not have a backlog. During the pandemic, we were actively doing diagnostic mammograms and biopsies. All our patients that were scheduled out into June and July, we're bringing them back slowly but surely. We do have hereditary risk management program that's built in, so patients that are higher risk are being brought back in first, especially if they if they missed their original appointment. We brought all our best radiologists back immediately. Everybody's working full time, so we're actually in good shape from the backlog standpoint.”
What counsel would you share with other imaging providers as they begin to reopen?
Melissa Marx: “The new normal is going to look different for everyone, but it’s most important to make sure you’re doing your cleaning schedules. Give your techs a little more time to do their cleaning between patients and ensuring that they’re staying protected. Be creative with your schedules. It’s important that we’re using creative ways to get patients back in, so these important screenings don’t get delayed more than they already have.”
Dr. Dee: “We went from overall imaging volumes being below 50 percent to now over 70 percent today. I think you had two choices in the pandemic, either to panic or to plan for the future. I think we’ve learned a lot about using technology like telemedicine and virtual waiting rooms, as well as using social media. I think all this is going to change the way we take care of patients going forward. If we can create a better, new normal out of this, I think that's what we're trying to achieve. I think we’ve learned we must focus on our patient experience to make them feel comfortable and trust us. And that, we're going to take to the future.”
Dr. Fried: “We must learn to function in this new normal. I can tell from the way my techs reacted early on during this, from being very fearful to the way they are now. They're much more comfortable with the idea of doing these exams, and I think patients are also more comfortable. I think the biggest thing we must be careful of though, is that we don't all get complacent. I think long term we need to be vigilant that we can't be the source of infection. We must do as much as we can to make sure that our patients and our techs remain protected - even when it's not first and foremost and everyone's mind.”
Click here to access a complimentary poster for your clinic that covers the cleaning and COVID-19 protocols discussed above including:
- Calling patients before their screening
- Conducting phone screens on patients before arrival
- Scheduling time for cleaning
- Rearranging waiting rooms
- Having patients wait in their cars until called
- Diagnostic imaging by remote radiologists
- Scheduling high-risk patients first
Click here to listen to a recent webinar with Dr. Dee and Dr. Fried in addition to Dr. Patton, OBGYN on this topic.
 Accessed on May 12, 2020: https://ehrn.org/wp-content/uploads/Preventive-Cancer-Screenings-during-COVID-19-Pandemic.pdf