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Setting up a three-stage pre-endoscopy triage during the coronavirus disease 2019 pandemic: A multicenter
Tao-Chieh Liu1, Chen-Ling Peng2, Fang-Yu Hsu3
1Department of Internal Medicine Division of Gastroenterology Tri-Service General Hospital, National Defense Medical Center Taipei Taiwan.
Insights
A three-stage pre-endoscopy triage system effectively screened patients during the COVID-19 pandemic, ensuring safe urgent procedures and protecting staff. This approach minimized nosocomial infections, demonstrating its utility in high-transmission periods.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Public Health
Background:
- The COVID-19 pandemic caused significant community transmission surges, necessitating adaptive healthcare strategies.
- Urgent endoscopic procedures require careful patient management to prevent disease spread.
- Protecting healthcare workers in endoscopy units is paramount during pandemics.
Purpose of the Study:
- To describe a three-stage pre-endoscopy triage process implemented during the COVID-19 pandemic in Taiwan.
- To evaluate the effectiveness of the triage system in supporting urgent endoscopic procedures while safeguarding staff.
- To assess the impact of the triage on patient screening and nosocomial infection rates.
Main Methods:
- A three-checkpoint triage framework was established at the hospital entrance, outpatient department, and endoscopy unit.
- Screening methods included temperature checks, travel/occupation/contact/clustering history, PCR assays, and rapid antigen tests.
- Data collected comprised procedure numbers, outpatient visits, and screening outcomes.
Main Results:
- The triage system facilitated rapid screening of symptomatic patients at the hospital entrance.
- Outpatient visits and endoscopic procedures decreased by 37% and 64%, respectively, during the pandemic.
- No endoscopy-related nosocomial COVID-19 infections were reported among 6540 screened patients (0.23% positive).
Conclusions:
- The three-stage pre-endoscopy triage, adaptable to local resources and prevalence, proved effective.
- The implemented measures successfully supported urgent endoscopic procedures during the COVID-19 pandemic.
- This triage strategy offers a valuable model for managing endoscopy services during infectious disease outbreaks.
Objectives:
Between May and July 2021, the coronavirus disease 2019 (COVID-19) pandemic led to a sharp surge in community transmission in Taiwan. We present a three-stage restructuring process of pre-endoscopy triage at the beginning of the pandemic, which can support urgent endoscopic procedures while protecting endoscopy staff.
Methods:
The pre-endoscopy triage framework was set up with three checkpoints at the hospital entrance, outpatient department, and endoscopy unit, with a specific target patient population and screening methods. Relevant data included the number of endoscopic procedures performed, outpatient department visits, and performing screening methods such as temperature measurement, travel, occupation, contact, and clustering history checking, polymerase chain reaction assay, and rapid antigen test.
Results:
Forehead temperature measurement and verification of travel, occupation, contact, and clustering history provided rapid, easy, and early mass screening of symptomatic patients at the hospital entrance. During the pandemic, outpatient department visits and endoscopic procedures decreased by 37% and 64%, respectively. The pre-endoscopy screening methods used displayed regional variations in COVID-19 prevalence. Among 16 endoscopy units with a community prevalence of ≥ 31.04 cases per 100,000 residents, 12 (75%) used polymerase chain reaction assay and four (25%) used rapid antigen test to identify asymptomatic patients before endoscopy. Of 6540 pre-endoscopy screening patients, 15 (0.23%) tested positive by laboratory testing. No endoscopy-related nosocomial COVID-19 infections were reported during the pandemic.
Conclusions:
We present a three-stage pre-endoscopy triage based on the local laboratory capacity, medical resources, and community prevalence. These measures could be useful during the COVID-19 pandemic.
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