S0529 UTMB Approach to Restarting Outpatient Endoscopy Amid the COVID-19 Pandemic

INTRODUCTION: The COVID-19 pandemic has led to widespread disruptions of outpatient endoscopic procedures The Division of Gastroenterology and Hepatology at UTMB developed a tiered strategy for risk stratifying pandemic-related cancellations, in an effort to systematically reschedule patients The Centers for Medicare and Medicaid Services, in concordance with multi- society guidelines, provided a framework for gradual reopening of outpatient procedures Here we describe the process and outcomes of the tier-based reinstitution of our outpatient endoscopy after flattening of the COVID-19 curve to provide urgent endoscopy services within a reasonable period applying appropriate risk mitigation precautions METHODS: Patients with pandemic-related cancellations from 3/16/2020 to 4/20/2020 were stratified into tier groups (1-4) in order of urgency (Table 1) During phase 1 of Texas's reopening, tiers 1 (urgent/emergent) and 2 (semi-urgent) were rescheduled within 1 and 4 weeks, respectively During phase 2, tiers 3 and 4 were subsequently rescheduled within 3 months Additional measures taken between phase 1 and 2 included pre-procedural testing of all inpatient and outpatients, employee testing, symptom screenings, surgical mask use, and internal social distancing Patients who chose not to reschedule were asked to provide their rationale (Table 2) RESULTS: Of the 540 patients awaiting delayed procedures, 14/16 (87 50%) patients in tier 1 and 147/170 (86 47%) patients in tier 2 could be contacted by phone to discuss the possibility for scheduling Of these, only 57 14% of tier 1 and 48 97% of tier 2 could be scheduled at their goal procedure interval Despite counseling on the safety measures instituted, the most commonly identified barrier for rescheduling urgent or semi-urgent endoscopy was COVID-19 related concerns in 40% Reassuringly, our pre-procedure COVID testing of the patients willing to return for their procedures revealed an incidence of 1 3%, as compared to 4 4% in Galveston county CONCLUSION: Our model describes a tier-based system that can be used to safely reintroduce elective procedures prioritized based on urgency The majority of patients across all tiers were rescheduled within 4 weeks We plan to contact patients 2 weeks after endoscopy to inquire about COVID-19 testing and results, which will allow us to evaluate the efficacy of our peri-procedural transmission prevention measures