Pre-Endoscopy real-time PCR testing for SARS-CoV2 does not reduce health care workers infection and is associated with a higher reduction of endoscopic activity in an outpatient setting.

Objective: The role of pre-procedure SARS-CoV2 testing in digestive endoscopy is still debated. AGA guidelines recommend against pre-procedure testing considering low prevalence of SARS- CoV2 infection in the general population and low incidence of infection among endoscopy units Health Care Workers (HCWs). However, no studies have compared pre-procedure testing associated to symptom screening vs. symptom screening alone in reducing the risk of infection for HCWs. Main aim of the present study is to compare the risk of infection for HCWs in different Endoscopy Units adopting different pre-endoscopy screening and operating in two nearby hospital of the same region in Northern Italy in pre-vaccination period. For outpatients in the Endoscopy Unit of Trento (Unit 1) only pre-procedure symptom screening was performed, while in the Endoscopy Unit of Bolzano (Unit 2) pre-procedure symptom screening and negative pre-procedure real-time PCR were requested. Secondary aims were to assess the impact of pre-procedure real-time PCR testing on endoscopic activity and diagnostic delay. Design: Retrospective data collection on a prospectively maintained database was performed, including outpatient endoscopy procedures performed between June 1st 2020 and February 28th 2021 in Unit 1 and Unit 2. Results: No differences in terms of infection rate in HCWs have been identified in Unit 1 and Unit 2 (9.0 vs. 19.3% P=0.2) over a nine-month period. Moreover, in the unit performing pre- procedure real-time PCR before endoscopy a significantly higher reduction in endoscopic activity has been recorded (61.9% vs. 53.4%; P<0.01). In patients with positive real-time PCR, endoscopy was performed with a mean delay of 61.7 days (range 9-294) and 22.5% of them were lost at follow-up and did not undergo any endoscopic procedure in the following 12 months. Conclusions: This study supports the AGA recommendation suggesting that pre-endoscopy real-time PCR is an expensive and time-consuming procedure without proven benefits in an outpatient setting.

Hospital responses to COVID-19: evidence from case studies to support future healthcare design research

Purpose: The Covid-19 pandemic has placed health-care systems and their facilities throughout the world under immense pressure. The pandemic has highlighted the crucial role of health-care facilities design in looking beyond the ongoing crisis and considering how hospitals can better prepare for unexpected future health situations. This study aims to investigate how hospitals reacted to the crisis in terms of their physical spaces, which architectural features permitted the necessary transformations, and how this data can inform hospital design research in the future. Design/methodology/approach: The research adopted a qualitative and multi-method approach to case studies. Data was collected directly (field survey and interviews) and indirectly (literature, periodicals, specialised websites, webinars, conferences and forums), and a strengths, weaknesses, opportunities, threats analysis supported the data evaluation. Findings: Hospitals’ responses to the crisis were guided by a host of variables depending on the specific intervention context and risk scenario. Some key issues emerged as particularly meaningful to drive future research in hospital design, namely, architectural typology, layout and spatial proximities, technological systems, the quality of care spaces, the role of public spaces, facility management tools to drive the transformation, territorial health care networks and new technologies. Originality/value: The paper suggests that the current crisis can be transformed into an opportunity, in terms of research and innovation, to rethink and improve the quality and efficiency of health-care spaces, restoring their crucial role of promoting health by design. © 2021, Emerald Publishing Limited.