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.
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:
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:
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.