This article is part of a new series helping members transition back into practice. See our first article by Aparajita Singh, MD, MPH, and Lukejohn Day, MD: How we managed our GI practice during COVID-19 in San Francisco.
Joseph Losurdo, MD, AGAF
Illinois Gastroenterology Group/The GI Alliance
As February drew to a close, the promise of spring was on the minds of many Americans. Many of us were planning vacations or scheduling spring and summer events. In the blink of an eye, the novel coronavirus pandemic changed all of our lives as it rapidly spread across the country.
COVID-19 challenged many social, economic and health care systems throughout the U. S. In an effort to curtail the spread COVID-19, many businesses were closed or offered reduced services as many states “locked down.” Health care was no exception and not immune to the crisis. Patient volumes and access to care shrank overnight. Elective procedures, emergency room visits and non-COVID hospitalizations withered away as patients were afraid to go to their physician’s office or the hospital for fear of contracting the virus. In addition, recommendations by the CDC were made to suspend all elective procedures. With medical care for millions of Americans being adversely affected, the medical community, along with CMS and commercial payors rapidly adopted a solution — telehealth visits. Telehealth visits allowed physicians and other health care providers to deliver much-needed care to their patients. However, although telehealth visits allowed for “office visits,” elective procedures were still not being performed. In addition, some patients were unaware of the telehealth option or continued to be afraid to contact their physicians. As a result, they continued with symptoms for a prolonged period of time. The backlog of patients grew.
As the focus of this pandemic shifted to learning to live with the threats of COVID-19, states began to relax their emergency restrictions. With these relaxed restrictions, the demand for health care services surged as elective procedures resumed and patients sought treatment for medical conditions they had endured. The question now arises, how do we safely alleviate this backlog of patients in this COVID-19 era?
First we must develop policies to keep patients, staff and clinicians as safe as possible. Reviewing guidelines from the CDC and your state’s department of public health may be a helpful start in developing these policies and processes. Some of these approaches may differ slightly between office and ambulatory surgical centers (ASC)/hospital. Consider initiating the following:
- Call patients the day prior to record medications, review of systems, changes in medical or surgical histories and allergies. These functions can also be performed via patient portals if available.
- Send email blasts to patients via their portals and to primary care physicians.
- Initiate COVID risk factor questionnaires. For example, ask patients if they have a fever, active COVID infection, travel to high risk areas, etc.
- Require everyone entering the office or building to wear masks and have their temperatures taken. Anyone with a temperature greater or equal to 100.4 degrees should be sent home immediately.
- Limit visitors to the office to only the patient unless the patient requires assistance from a single family member.
- Arrange exam rooms and waiting areas to maximize social distancing as best as possible.
- Remove magazines, refreshments etc. from waiting rooms.
- Stagger telehealth visits with in person visits to limit the number of patients in the waiting room.
- Wipe down and disinfect exam rooms after each patient visit.
- Consider COVID testing several days prior for ASC/hospital procedures, if not already mandated by your state’s department of public health.
- Adjust HVAC to increase air circulation in procedure rooms.
- Increase interval between patient procedures in order to deep clean the room after each procedure.
- Request drivers to wait in their car rather than waiting rooms until the patient is ready to be discharged after their procedure.
Once safety measures are in place, consider which patient should be seen first and whether they are seen in person or by a telehealth visit. Priority should be given to patients with:
- New or ongoing symptoms, such as abdominal pain, diarrhea, rectal pain or rectal bleeding.
- Abnormal labs or imaging studies for example, new onset anemia or a mass noted in the pancreas or liver.
- Long overdue surveillance studies.
- Patients who have inflammatory bowel disease who have uncontrolled symptoms.
Patients with stable, well controlled disorders, routine follow-up, screening colonoscopy or polyp surveillance which is recently due for follow-up colonoscopy may still be postponed unless there is available office appointment times.
Other strategies which can aid in reducing the backlog of patients include:
- Extending office hours during the week.
- Consider adding weekend hours both for office appointments and procedures.
- Postponing or deferring vacations if possible in order to increase the number of appointment slots.
- If your office employs nurse practitioners or physician assistants who are furloughed, recalling the nurse practitioners and physicians assistant back to see patients will also help decrease the backlog.
It is unavoidable that these policies will need to be continuously amended as we further develop an understanding of this disease. As a result, practitioners should stay informed and remain up to date with current guidelines submitted by the CDC. They should also continue to review their state’s health department recommendations and follow trends in local cases, hospital census and deaths.
It may take time to get accustomed to these changes to our patient care protocols. However, coronavirus has changed every aspect of our lives and health care was no exception. Hopefully, with a new focus on limiting transmission of the disease, it will no longer be necessary to limit health care services. Going forward, we will be able to decrease the backlog of patients and continue to deliver excellent care.
