Abstract
BackgroundThe COVID-19 pandemic has led to disruptions in elective and outpatient procedures. Guidance from the Centers for Medicare and Medicaid Services provided a framework for gradual reopening of outpatient clinical operations. As the infrastructure to restart endoscopy has been more clearly described, patient concerns regarding viral transmission during the procedure have been identified. Moreover, the efficacy of the measures in preventing transmission have not been clearly delineated.MethodsWe identified patients with pandemic-related procedure cancellations from 3/16/2020 to 4/20/2020. Patients were stratified into tier groups (1–4) by urgency. Procedures were performed using our hospital risk mitigation strategies to minimize transmission risk. Patients who subsequently developed symptoms or tested for COVID-19 were recorded.ResultsAmong patients requiring emergent procedures, 57.14% could be scheduled at their originally intended interval. COVID-19 concerns represented the most common rescheduling barrier. No patients who underwent post-procedure testing were positive for COVID-19. No cases of endoscopy staff transmission were identified.ConclusionsNon-COVID-19 related patient care during the pandemic is a challenging process that evolved with the spread of infection, requiring dynamic monitoring and protocol optimization. We describe our successful model for reopening endoscopy suites using a tier-based system for safe reintroduction of elective procedures while minimizing transmission to patients and staff. Important barriers included financial and transmission concerns that need to be addressed to enable the return to pre-pandemic utilization of elective endoscopic procedures.
Highlights
The COVID-19 pandemic has led to disruptions in elective and outpatient procedures
Since patient perception of procedure associated infection has been identified as a significant concern when restarting outpatient elective procedures, it is crucial to assess the safety of our procedures to ensure ongoing appropriate utilization of outpatient endoscopy [2]
Even with the capability to accommodate for all tier 1 and tier 2 patients, the average delay of endoscopy from the initial scheduled procedure date to index endoscopy was 32 days, with the longest delay being 86 days
Summary
The COVID-19 pandemic has led to disruptions in elective and outpatient procedures. As the infrastructure to restart endoscopy has been more clearly described, patient concerns regarding viral transmission during the procedure have been identified. Since the first documented case of COVID-19 in the United States (US) on January 21, 2020, many hospitals have had to enact strict measures to prevent further spread of the virus among the population. Little is currently known regarding the efficacy of these measures in preventing transmission of the novel virus to staff and patients in this context. Since patient perception of procedure associated infection has been identified as a significant concern when restarting outpatient elective procedures, it is crucial to assess the safety of our procedures to ensure ongoing appropriate utilization of outpatient endoscopy [2]. Soon after on March 17, 2020, the American College of Surgeons, American Gastroenterological Association (AGA), and the other national gastroenterology societies recommended rescheduling elective procedures to focus only urgent and emergent endoscopic procedures [6,7,8]
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