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WORKING SMARTER NOT HARDER: USING SIMULATION TO EVALUATE EVIDENCE-BASED STRATEGIES TO OFFLOAD COLONOSCOPY BACKLOGS RELATED TO COVID-19
Gastroenterology ; 160(6):S-27-S-28, 2021.
Article in English | EMBASE | ID: covidwho-1598935
ABSTRACT

Background:

The COVID-19 pandemic has temporarily reduced capacity in many endoscopyunits, creating long backlogs, which have the potential to worsen patient outcomes.

Aims:

To evaluate the impact of two evidence-based strategies for offloading colonoscopy demandduring and after the first wave of the pandemic (1) An “Extend” strategy, in which theinterval for low-risk adenoma (LRA) patients who are currently “due” is extended from 5years to 7 years;(2) An “Exchange” strategy, in which all referrals for screening colonoscopyare changed to fecal immunochemical testing (FIT);(3) a combination of “Extend+Exchange.”

Methods:

We developed a discrete-event simulation of an endoscopy unit in an integratedhealthcare system with a caseload of 110 procedures weekly. We assumed capacity initiallyfell to 5% of pre-COVID levels for 10 weeks (as a result of the pandemic), and incrementallyincreased back to 100% by 30 weeks. Each week, 113 patients were referred with thefollowing indications, in order of priority diagnostic colonoscopy (23% of referrals) and upper endoscopy (28%), high-risk adenoma (HRA) surveillance (10%), LRA surveillance(17%), and screening colonoscopy (22%). The highest priority patients were always seenfirst, while others joined a queue. Outcomes included average wait time, number of patientsseen, and queue size at model’s end. The base unit of time was weeks. Model length was150 weeks. One-way sensitivity analyses were performed for all variables. Each strategy wassimulated 500 times in C++ and compared to a base case in which no offloading strategieswere used.

Results:

In the base case, 3,023 patients remained in queue at 150 weeks, andthe average wait time was 22.5 weeks overall. The wait time for screening colonoscopy was69.9 weeks. With the Extend strategy, 1,293 patients remained in queue at 150 weeks, theaverage wait time was 14.2 weeks overall, and the wait time for screening colonoscopy was41.6 weeks. With Exchange, no patients remained in queue at 150 weeks, and the averagewait time was 9.9 weeks. Because no screening colonoscopies were done, there was no waittime for this indication. The Extend+Exchange strategy yielded similar results, but the averagewait time was 5.3 weeks. In all four strategies, nearly equivalent numbers of patients wereseen for HRA surveillance (range 2,496-2,511), diagnostic colonoscopy (range 4,547-5,062),and upper endoscopy (3,749-3,759), with similar wait times. None of the strategies hadwait times for upper endoscopy or diagnostic colonoscopy exceeding 5 weeks.

Conclusions:

Without offloading strategies, prolonged queues and wait times developed, especially forscreening colonoscopies. Substituting FIT for screening colonoscopy (Exchange) is the singlestrategy with the greatest potential to mitigate these problems, without which patients maysuffer harm caused by limited access.(Figure Presented)Figure 1. Average wait time by indication under usual care, and three evidence-based strategies for offloading endoscopy demand during the COVID-19 pandemic.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Gastroenterology Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Gastroenterology Year: 2021 Document Type: Article