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 Table of Contents  
LETTER TO THE EDITOR
Year : 2021  |  Volume : 8  |  Issue : 4  |  Page : 174-176

Reduction of door-to-chest computed tomographic time in a fever clinic following anti-COVID-19 efforts


1 Department of Vascular Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
2 Fever Clinics, Department of Infection, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China

Date of Submission11-Jul-2021
Date of Acceptance07-Nov-2021
Date of Web Publication17-Aug-2022

Correspondence Address:
Minggui Lin
Department of Infection, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Litang Road 168, Changping, Beijing 102218
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/RID.RID_24_21

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How to cite this article:
Yang Y, Lin M, Wu W. Reduction of door-to-chest computed tomographic time in a fever clinic following anti-COVID-19 efforts. Radiol Infect Dis 2021;8:174-6

How to cite this URL:
Yang Y, Lin M, Wu W. Reduction of door-to-chest computed tomographic time in a fever clinic following anti-COVID-19 efforts. Radiol Infect Dis [serial online] 2021 [cited 2022 Oct 6];8:174-6. Available from: http://www.ridiseases.org/text.asp?2021/8/4/174/353895



To the Editor,

Coronavirus disease 2019 (COVID-19) spread worldwide in 2020. Chest computed tomography (CT) can effectively diagnose pneumonia and identify suspected patients at an early stage.[1] Bilateral ground-glass opacities in the outfield, consolidation, air bronchi signs, paving stone signs, fibrous lesions, vascular thickening, and halo signs are common CT features of COVID-19.[2] The sensitivity of chest CT imaging for COVID-19 was reported to be 97%.[3] On February 12, 2020, over 10,000 cases were announced in China, and the National Health Commission put more emphasis on the value of chest CT images. Our hospital set up a CT green passage for fever clinic patients.


  Computed Tomographic Use for Coronavirus Disease 2019 cases in 2020 Top


Between January 25 and March 3, 2020, 72 chest CT-positive fever clinic patients were sent directly to the surveillance room for a nucleic acid test and were then transferred to designated hospitals following the national criterion.[4] We set up a CT green passage for the fever clinic on February 12, providing independent CT equipment and space, separate from those used for emergency patients. Full-time “guiders” led fever patients to the individual CT room through a reserved access area. These initial 72 patients were divided into two groups: the anterior group (Group A) included 34 patients who presented at the fever clinic before February 12, 2020, and the posterior group (Group P) included 38 patients who presented at the fever clinic after February 12, 2020. The time cost for every step of the chest CT test was calculated from the time a patient checked in at the door of the fever clinic [Figure 1]. The door-to-prescription (d-p) time (39.09 ± 7.32 min vs. 13.66 ± 2.40 min, P = 0.0009), door-to-chest CT (d-CT) time (71.62 ± 9.05 min vs. 49.53 ± 3.98 min, P = 0.0234), and door-to-room (d-r) time (234.5 ± 17.3 min vs. 181.0 ± 9.4 min, P = 0.0066) were longer in Group A than in Group P, while there was no statistically significant difference in the CT time and consulting time [Table 1]. Almost 1 h per patient was saved by the progress made in our CT green passage effort. The quick chest CT test and faster transfer to the surveillance room shortened the patients' stays in the fever clinic and reduced the exposure of medical staff and other patients to suspected infected cases.
Figure 1: Every step from the door of the fever clinic to acquisition of chest CT images. d-p: Door-to-prescription time; d-CT: Door-to-chest CT time; d-r time: Door-to-room time; PACS: Picture archiving and communication system; COVID-19: Coronavirus disease 2019; CT: Computed tomography

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Table 1: Diagnostic time distribution for suspected patients in the fever clinic

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  Anti-coronavirus Disease 2019 Data in 2021 Top


We designed and built a brand-new fever clinic building with an independent CT room beside clinic rooms within the 6 months, and opened the clinic on 20 Nov 2020, a 51-year-old man with COVID-19 presented at our fever clinic. His d-p time was 7 min, d-CT time was 24 min, and d-r time was 29 min, which were much shorter than those in 2020. Although nucleic acid testing kits were more available 1 year after the initial outbreak, the CT results were obtained sooner than the laboratory tests.

The door-to-balloon time is essential for cardiologists in acute coronary syndrome,[5] and the door-to-reperfusion time is essential for neurologists in acute ischemic stroke and acute stroke emergency care processes.[6],[7] The d-CT time is essential for the early recognition of suspected patients. A CT green passage might be a useful method to prevent hospital infection in the early stage of efforts to prevent a respiratory pandemic disease when etiological detection is unavailable. The d-CT time might be considered a quality control time metric for hospital infection prevention in fever clinics.

Globally, over 90 million people have already been infected with COVID-19,[8] and we hope that more effective anti-COVID-19 strategies can be shared and adopted to prevent patient and hospital infection.

Limitations

Because of strict lockdown and isolation procedures in China, there were very few COVID-19 cases in Beijing. There were no hospital-infected case numbers in our hospital in either the anterior period or the posterior period, and it is therefore not possible to provide evidence for reduced hospital infection in our institution. A wider study with more centers might be considered.

Acknowledgment

We thank Liwen Bianji (Edanz) (www.liwenbianji.cn) for editing the English text of a draft of this manuscript.

Financial support and sponsorship

Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital Science Funding for Junior Fellows (No. 12017C1004) supported the study.

Conflicts of interest

There are no conflicts of interest.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.



 
  References Top

1.
Lin C, Ding Y, Xie B, Sun Z, Li X, Chen Z, et al. Asymptomatic novel coronavirus pneumonia patient outside Wuhan: The value of CT images in the course of the disease. Clin Imaging 2020;63:7-9.  Back to cited text no. 1
    
2.
Chen H, Ai L, Lu H, Li H. Clinical and imaging features of COVID-19. Radiol Infect Dis 2020;7:43-50.  Back to cited text no. 2
    
3.
Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology 2020;296:E32-40.  Back to cited text no. 3
    
4.
Wei-Jie G, Zheng-Yi N, Yu H, Wen-Hua L, Chun-Quan O, Jian-Xing H, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.  Back to cited text no. 4
    
5.
Foo CY, Bonsu KO, Nallamothu BK, Reid CM, Dhippayom T, Reidpath DD, et al. Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: A meta-analysis. Heart 2018;104:1362-9.  Back to cited text no. 5
    
6.
McTaggart RA, Ansari SA, Goyal M, Abruzzo TA, Albani B, Arthur AJ, et al. Initial hospital management of patients with emergent large vessel occlusion (ELVO): Report of the standards and guidelines committee of the Society of NeuroInterventional Surgery. J Neurointerv Surg 2017;9:316-23.  Back to cited text no. 6
    
7.
Bilotta M, Sigal AP, Shah A, Martin A, Schlappy DA, Sorensen G, et al. A novel use of prehospital telemedicine to decrease door to computed tomography results in acute strokes. J Healthc Qual 2020;42:264-8.  Back to cited text no. 7
    
8.
Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/. [Last accessed on 2022 Mar 25].  Back to cited text no. 8
    


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