Safe Endoscopy and Office Practices During the COVID-19 Crisis
Dear Colleagues,

In a time of so much uncertainty, it is common to look for a sense of reassurance as well as sources of strength. At the PSG, we want to help our gastroenterology providers with some guidance during this crisis situation. During this unprecedented time, we stand ready to help and continue to advocate on your behalf and on behalf of your patients. 

Our PSG Practice Management Task Force , Chaired by Dr. Ralph McKibbin, has been working diligently to create some general principals of practice management during these trying times. Please realize that the situation is fluid and these recommendations may change anytime. I hope you find the recommendations, which are attached to this email, to be of value to you and your patients. Thank you for your support. We are all in this togethe r. I wish for you and your family to remain safe and healthy during this unsettling period.

Warm Regards.
Ravi Ghanta, MD
PSG Practice Management Task Force
Ralph D. McKibbin, MD, Chairman
F. Wilson Jackson, MD
Louis LaLuna, MD
Richard Moses, DO
Fraser Stokes, MD

In response to the COVID-19 pandemic crisis the PSG Practice Management Task Force held an emergency phone conference to discuss safe practice tips and assemble a resource list to help Pennsylvania gastroenterologists manage the rapid changes necessary to combat the COVD-19 pandemic. Resources vary by practice size and geography, but these tips, ideas and resources will help you get things done safely and efficiently.  
General Recommendations
  • Recommendations and executive orders are changing daily. All policies should be reviewed frequently.
  • Procedures should be classified as to urgency and risk. CMS and other groups have put out recommendations for which patients might still undergo endoscopy procedures. If deciding to perform cases, schedules should be compressed. Documenting risk assessment in the patient’s chart should be considered.
  • Pre-screen all patients for exposure or symptoms of infection before entering the endoscopy facility. Patients should be asked about a history of fever or respiratory symptoms, family members or close contacts with similar symptoms, any contact with a confirmed case of COVID-19, and recent travel to a high-risk area per CDC recommendations. Review guidelines for current recommendations as to where patients can be served.
  • Have family members and other escorts wait in their vehicles during procedures for patient visits. Have the patient meet their escort outside the building unless absolutely necessary otherwise. The escort can be texted if they need to enter the building, however they will also then need to be screened prior to entering. 
  • Avoid bringing patients (or escorts) into the medical facility who are over age 65 years old or have disease risk factors.
  • Patients on immunosuppressive drugs for IBD and autoimmune hepatitis are currently recommended to continue taking their medications as the risk of disease flare outweighs the risk of contracting coronavirus. These patients should also follow CDC guidelines for at-risk groups by avoiding crowds and limiting travel.
  • Make sure appropriate personal protective equipment (PPE) is available and worn by all members of the endoscopy team in the proper recommended manner.
  • Review PPE procedures. See the link for how to don PPE.
  • Check the body temperature of the patient upon arrival at endoscopy unit or clinic. This should be done at the door as the patient enters the building.  
  • Practice social distancing and always maintain a 6 foot separation.
  • Conserve PPE. Only essential personnel should be present in cases.
  • For COVID-19 positive patients, or those awaiting test result results, isolation precautions should be taken with procedures performed in negative pressure rooms if available per facility guidelines.
  • Adopt Telehealth as soon as possible to minimize physical contact while still providing needed services.
  • Consider phone follow-up at 7 and 14 days to ask about new diagnosis, or development of symptoms, of COVID-19.
  • Address staff needs and institute policies that protect your workforce. Maximize work from home for such tasks as chart and laboratory reviews, et cetera.
  • Consider dividing staff into teams that alternate schedules/tasks. Review back to work policy after exposure for healthcare workers guidance. Stay informed as these policies are likely to change.
  • Consider taking staff temperatures before beginning work. This could limit office exposure but also reinforces not working when ill and reduces work place anxiety.
  • Consider morale-boosting activities (lunch/treats/music/breaks, et cetera.)
Telehealth and Telemedicine Resources
Pennsylvania Carrier Telehealth Policies
Policies change frequently. Please contact the carrier directly to ensure up-to-date information.

@PaGastroSoc #PAGastro