Shaping better health
REMEDY : BNSSG referral pathways & Joint Formulary

Radiology during COVID-19

Checked: 30-07-2020 by vicky.ryan Next Review: 30-10-2020

Overview

**Update 24.06.20**

With effect from Monday 6th July 2020 routine requests for Radiological investigations will reopen in the Imaging departments at NBT & UHBW.

Patients referred after this date will be added to the waiting lists at each Trust, however please be aware that there is currently no timeline for the scheduling of routine activity.

We continue to prioritise available capacity for cancer and urgent referrals, which will be followed by prioritisation to clear the extensive backlog of patients that has accumulated over the last 3 months. Please note that there are capacity issues affecting all imaging modalities at all hospital sites.

The key messages for primary care are:

We would very much value your help in managing patient expectations regarding waiting times at the time of requesting the test. Once the full extent of the waiting list is visible, we will endeavour to advise you on expected waiting times for examinations. In the meantime, we would ask that you advise your patients of the current situation and ask them not to contact the Radiology departments directly regarding their place on the waiting list, as this will divert administrative resource away from making appointments and will add further delay into the system.

Work is on-going in relation to demand management and it may be possible that following this piece of work, the thresholds for certain diagnostic examinations are changed. This could result in some requests being removed from the waiting list and returned to the referrer. As a system we are doing everything possible to use all available imaging capacity in the region, including independent sector options, but there will be significantly less capacity than before COVID.

If any of your patients re-present with new or exacerbated symptoms and you wish to amend the urgency of your referral, please contact the relevant department using the contact details below, and include any relevant additional clinical information.

Please see the full updates which includes priorities, referral considerations and escalation for patients clinically deteriorating:

BNSSG System-wide Radiology - Restarting Routine Referrals 24.06.20

BNSSG Radiology COVID-19 Update to Primary Care 05.06.20

RUH presents a similar picture RUH Radiology Update to Primary Care 20.05.20

Imaging referrals and new booking systems

As part of the process to restore Imaging Services following the outbreak of COVID-19, both North Bristol Trust (NBT) and University Hospitals Bristol and Weston (UHBW) have released letters about the need to amend the ways of working to ensure patient and staff safety when booking in plain imaging referrals.

North Bristol Trust:

  • From Monday 27 July 2020, patients requiring Plain X-ray will no longer be able to walk-in and wait to have their X-ray. All patients will need to have an appointment. To make an appointment, they will need to call 0117 4145175.
  • Should a request be urgent i.e. Query Pneumothorax, or query fracture; please ask the patient to attend Southmead Hospital, Gate 18, Imaging department between 9am – 4pm, in order to expedite the Imaging. For this group of patients there will be no need for an appointment but if the patient has any symptoms of Covid-19 please ask them to contact the appointment team to be offered instruction relating to the most appropriate way to attend for X-Ray.
  • Please issue patient leaflet attached. (link to leaflet on CCG Website: https://bnssgccg.nhs.uk/library/x-ray-booking-details-north-bristol-nhs-trust/)

UH Bristol and Weston:

  • All patients requiring Plain X-ray will no longer be able to walk-in and wait to have their X-ray. All patients will need to have an appointment. Patients will need to call the department on 0117 342 2407 (Mon-Fri, 9am-4pm) or 0117 342 9695 (Mon-Fri, 5-7pm or Sat/Sun, 8.30am-7.30pm).
  • For urgent imaging requests, there is no need for practices to book an appointment for this cohort of patients, but should to ask the patient to attend the BRI between 9am-5pm. If the patient has any symptoms of Covid-19 please ask them to contact the radiology department prior to their imaging.
  • For urgent paediatric requests, patients are asked to attend the BRHC between 9:30am-11:30am or 2pm-4pm. There will be no need to book an appointment for this cohort of patients. If the patient has any symptoms of Covid-19 please ask them to contact the radiology department prior to their imaging. 
  • Please issue patient leaflet attached. (link to leaflet on CCG Website: https://bnssgccg.nhs.uk/library/x-ray-booking-details-university-hospitals-bristol-and-weston-nhs-foundation-trust/)
  • Referrals remain the same at Weston who have never had open-access X-Ray (other than chest XR & fractures - please see attached communication )

Radiology Queries and Advice

These are very testing times for our teams, and we acknowledge how difficult it is for GPs and patients. As always, we are happy to discuss any patients that you are concerned about, and will endeavour to accommodate any patients who are in need of urgent diagnostic imaging.

NBT

Please call the Imaging Secretary of the Day on 0117 414 9110 (for urgent enquiries). A Consultant Radiologist will also be available between 11am-3pm each working day from 6 July until 28 August 2020 to discuss imaging queries including the value and appropriateness of different imaging investigations.

or otherwise email the GP specific inbox: nbn-tr.radiologygpqueries@nhs.net if you have a specific query regarding any of your patients that requires discussion with a Radiologist. 

UH Bristol

If there is any clinical concern about any of your patients please contact the Radiology Admin Team on:

ubh-tr.radiologyadminbri@nhs.net (Adults)

ubh-tr.RadiologyAdminBRHC@nhs.net (Paediatrics)

Weston General

For queries please call 01934 647 203

Wnt-tr.radiologysecretaries@nhs.net

RUH Bath

ruh-tr.radiologyresults@nhs.net

For urgent Radiology advice 8am – 5pm Mon-Fri, please contact the Radiology secretaries (ext 1174/6985) who will be able to put you through to the most appropriate subspecialty Radiologist to answer your query. Please indicate if a call back or email communication would be more convenient.

For urgent out of hours queries (5pm-8pm Mon - Fri and 8.30am - 5.30pm Sat and Sun), please contact the on call Radiologist (ext 6927/6875).

USS Guided Steroid Injections

GPs are asked not to request +/- steroid injection when requesting a diagnostic ultrasound.

Due to current pressures on radiology and risks involved with steroid injections the radiologists at NBT and UHBW have advised that they can no longer provide an open access service for USS guided injections with immediate effect.

A referral can be made for USS guided injection if diagnosis has already been confirmed and criteria are met as outlined in the following document:

Referral Guidance for Image Guided Steroid Injections

Please note that referrals for surgical removal of ganglions are subject to an exceptional funding policy.

Advice on imaging of musculoskeletal conditions can be found in Remedy on the Radiology Guidelines for Primary Care page.

Guidelines on use of steroid injections in the community were released by NHS England on 31.7.20:

Clarification regarding corticosteroid injections for GPs, First Contact and Community Physiotherapists 

Corticosteroid injections (intraarticular and intramuscular) may be used where clinically indicated and the benefits outweigh the risks. An individual risk analysis must take place on a case by case basis and the lowest possible dose of corticosteroid must be used.

A corticosteroid injection must not be performed if the patient has an infection or suspected infection, including possible COVID-19 infection, being mindful that the incubation period for COVID-19 can be up to 14 days.

Patients must be aware of the potential increased risk and lack of clear evidence related to the risk of corticosteroid injections during the COVID-19 pandemic. Informed consent must be obtained and documented prior to proceeding with the injection.

Please see the full guidance which contains more details including caveats.