Like many in healthcare across the country, the UVA Radiology CT team has had to adapt to our radically different, COVID-19 world. As a critical, front-line component of care at UVA Health, and as a place where patients from all corners of the medical system are brought for imaging, COVID-19 has had an outsize impact on how the CT team functions.
“People (outside the Radiology department) might not know how pivotal we are and just how many patients we see” says Daniel Phelps, CT Chief Technologist. “Our team had to really step up and figure out what needed to be done.”
A Critical Part of the Care Team
The CT team is responsible for CT (computed tomography) imaging of UVA Health patients at three sites: in the main hospital, where the team does 24/7 inpatient imaging for the hospital (including for the emergency room) as well as outpatient imaging, and at two additional outpatient sites – one in the Education Resource Center and one in the Emily Couric Clinical Cancer Center. At these three sites, approximately 30 technologists will image 150 patients a day on seven CT machines. On a busy day, 200 patients or more might need imaging.
Each patient requires a different protocol for imaging the exact part of the body that their doctor needs to see. At most imaging centers, technologists might have to learn around 20 imaging protocols for different suspected injuries or diseases processes in specific areas of the body. But because UVA Health is a major teaching hospital and level 1 trauma center, the CT staff has to learn many more protocols. “We’re more advanced than other hospitals in the area, ” says Phelps. “We have four different divisions (we are imaging for) with perhaps 20 or more protocols in each division.”
It’s this challenge that draws many CT technologists to work at UVA. “One of the challenges is getting used to all the protocols,” says CT Technologist Cody Desper. “But that’s what makes it fun – you see a little bit of everything.”
An Unprecedented Time
When COVID first spread across the United States in March, the CT team, like care providers everywhere, tried to quickly understand what precautions needed to be taken to keep patients and team members safe. Besides adopting appropriate safety protocols for team members – N95 masks, gowns, gloves, eye protection – they also adopted disinfecting and cleaning procedures. In those early days, the CT team divided into two groups, each of whom did rotating 12-hour shifts. That way, if a team member did get COVID, they would, at most, only expose half of the total technologists to the virus.
CT scans of the lungs can be a part of assessing the severity of COVID-19-related lung damage, and even confirmation of a diagnosis. Because of that, CT technologists are in direct contact with patients who are confirmed to have COVID-19. They also image patients who are suspected to have COVID but don’t yet have a positive test. Those patients, who are referred to as PUIs, or patients under investigation, must be treated as if they will be confirmed positive for COVID.
All COVID patients and PUIs require a cleaning of the room. “But a positive COVID patient throws a wrench in things,” Phelps explains, because the CT room where they have their scan done must be taken offline for at least an hour so that housekeeping can do a deep clean. And special category of PUIs – trauma patients who are intubated, and thus unable to have a COVID test – also require that CT scanners be taken offline for at least an hour because of the unknown risk of them having the virus.
Those offline hours have a huge effect on CT’s capacity. With only seven total machines imaging 150-200 patients a day, the job is always a juggling act. But with 3-4 COVID-positive patients and 5-6 intubated PUIs a day, those offline hours start to add up and strains an already difficult schedule.
Now, patients are returning to the health system for more routine care. “So the outpatient load is ramping back up,” Phelps says. “We’re having to juggle even more patients in main department plus the outpatient sites.”
Stepping Up as a Team
There’s no question the extra protocols and long shifts have been stressful for his team, Phelps says. “We’ve been flexible and gone with the flow as we’ve learned with COVID. But it’s stressful for everyone. You can tell there’s wear and tear. It’s part of the job but it needs to be addressed.”
On top of COVID, CT faces a national shortage of trained technologists. UVA is not immune. “We’re down around 6 technologists,” says Phelps. “Everyone is picking up extra shifts, rotating schedules and filling in spots so that the department can run.” Technologists are volunteering for night shifts, which is essential because inpatient imaging continues 24 hours a day. Phelps is proud of his team. But he wants people to know how much dedication and sacrifice this time has required from them. “Most people don’t realize just how much we actually do,” he says. “They don’t realize how many patients are being scanned, and how integral we are to every service line at the hospital.”
Looking Out for One Another
For some, the challenges of this time are made even more plain. Cody Desper and his wife, for example, had their first baby in May, back in the early days of the pandemic. Working in such close proximity to COVID-positive patients and other team members has required tremendous discipline and care. “We want to protect not only our patients, but each other,” says Desper. “If one of us gets sick, we’re working in close quarters and others can easily get sick. We’re trying to keep everyone healthy and not bring this home (to our families).”
Desper continues, “We’re pretty much always here. When someone asks me if I’m working tomorrow, I always joke, ‘Yep, this is home!'” But though it’s been challenging, Desper sees the comradery and commitment each of his coworkers brings to their roles. “We’re doing critical staffing and working more hours,” he says. “But we all work hard together, and we all work well together. Everyone steps up and picks up shifts. It says a lot, I think, that everyone has stayed here at UVA. We enjoy it. And we’re all looking out for one another.”