COMMENTARY

Reopening Endoscopy Centers: Expert Advice

Klaus Mergener, MD, PhD; Carol A. Burke, MD; Joseph J. Vicari, MD

Disclosures

July 13, 2020

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This transcript has been edited for clarity.

Klaus Mergener, MD, PhD: The impact of COVID-19 on endoscopy centers has been massive. Most of our centers do predominantly elective procedures, so they were completely shut down for several weeks.

Carol A. Burke, MD: In addition, we have had a downturn in patients coming in to access care both in the endoscopy suite and in the offices. Some institutions and some practices had to furlough or fire employees.

Joseph J. Vicari, MD: After weathering that initial impact of either closing for a short period of time or greatly reducing services, we are now in the phase of reopening and trying to bring back our patients and bring back the endoscopy center volume.

Starting to Reopen

Burke: We are looking at thousands of patients who are in need of services. We've had nursing personnel and medical assistants who usually do face-to-face visits — because those have decreased a little bit — call patients to say, "We're open for business, and would you like to come in?"

Mergener: We're currently at a point where we're hoping to be able to reopen endoscopy centers back up to a significant percentage of pre–COVID-19 operations. Many centers around the country are telling me that they have reopened and are currently running at about 50% of capacity. They're hoping to get back closer to 100% by the end of the year.

Burke: About 50% of patients have decided to come in. Other patients have decided to wait until COVID-19 is over. When I have conversations with my patients about coming in when COVID-19 is over, I tell them that we don't really know when that is going to be. Personally, I think that we're as safe as we're going to get within gastroenterology practices, both small and large, and institutions.

Patient Safety Reassurances

Mergener: A critical element of reopening endoscopy centers has to do with making patients feel that they can safely return. There are significant concerns about the transmission of COVID-19. But there are also concerns about the safety of undergoing an endoscopy and even whether the instruments we use to perform our procedures are properly cleaned.

Vicari: Most centers, at a minimum, are using a COVID-19 questionnaire to try to filter out any patients who may be at risk or have symptoms consistent with COVID-19. They're also using questionnaires to screen staff who may have signs or symptoms consistent with COVID-19.

Burke: To ensure safety in our institution, we're doing thermal scanning or temperature checks, asking COVID-19–related questions, and offering masks to all individuals who come in to our institution. We've limited the number of visitors in the endoscopy centers and the hospital practice.

Vicari: Some states have mandated COVID-19 testing. In the state of Illinois, where I live, we have mandated COVID-19 testing. Initially we were concerned that it could be a hurdle — that is, patients would resist the need to undergo COVID-19 testing. But in the end, what we initially thought was a hurdle may now be a benefit. As we see patients start to come back, they are embracing COVID-19 testing.

PPE Use

Mergener: One way we've changed our operations in endoscopy centers is by making sure that staff, physicians, and patients are appropriately protected by personal protective equipment (PPE). That adds to the cost of operations.

Vicari: The financial impact for PPE is important and significant. For gastroenterology, we have now added protective equipment that we would not typically use. For example, we did not typically use the standard surgical masks. Now we are using N95 masks, which have a higher cost than the standard surgical masks. We're using face shields. We're also using shoe covers, and we were using hair bonnets. These are small increases in the cost of doing business in the endoscopy center.

Impacts on Efficiency

Mergener: As we are opening endoscopy centers, one significant concern is not getting back to full operations and meaningful efficiency. We're running centers at only about 50%-70%.

Vicari: Efficiency has changed. After we started to do elective procedures again, we needed to increase the room turnover time to allow for proper cleaning of the room, and also to allow infectious particles to settle if someone was infected with COVID-19 in that room. So procedure times extended to 1 hour as opposed to 30 minutes. Groups are slowly coming back; some are at 50 minutes and others are at 40 minutes.

Best Practices for Reopening

Burke: I would like to offer some tips to my colleagues in gastroenterology to ensure that they're ready to continue to manage patients in the most effective way in their practices, because COVID-19 is not gone and there is so much we don't know about it.

If they haven't already, I would suggest that small and large practices really spend the time, energy, and money on information technology. Get a platform that is effective, reliable, and secure.

Also, make sure that the messaging from your practice is consistent in terms of how you're able to keep your patients safe from COVID-19. Know the metrics in the unit and whether there have been any COVID-19–related infections.

Vicari I think the key is to be patient. Don't be pessimistic if it's not returning quickly over weeks; we need to look at months. Hopefully, we can have a slow, steady march forward with referrals that turn into endoscopic procedures. But it is going to take time, so one word to keep in mind is patience.

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