A MODEL OF RELOCATION OF GASTROENTEROLOGICAL PROCEDURES SUSPENDED DURING FIRST COVID 19 LOCKDOWN: THE EXPERIENCE OF BOLOGNA EMERGENCY GASTROPACK PROJECT

ABSTRACT

Background and aim: Due to COVID-19 spread, in March 2020 Emilia Romagna government ordered the first lockdown blocking non-urgent health services. After 4 months, regional health service reopened but thousands of people had pending requests. In order to avoid the excess of requests to create jams in the system, we established a controlled reopening according to criteria of prescriptive appropriateness and clinical priority, called Emergency-Gastropack (E-GPack). Aim of present study is to evaluate the outcomes of this project. Materials and methods: Non-urgent sanitary activity was suspended between March 6, 2020 and July 10. From May 7 to June 12, the E-GPack was carried out. The system is based on the collaboration between hospital Gastroenterolgists and GPs. The Department of Primary Care informed the GPs that had made requests suspended during the lockdown, agreeing a telephone appointment with the Gastroenterologist. For each request a digitalised record was created in the RIS-PACS software (Polaris). On the scheduled date and time, the Gastroenterologist contacted the GP to discuss the clinical case that led to the suspended request. Based on the original indication and on the possible clinical evolution occurred meanwhile, different outcomes were possible confirmation of the request with different priority (to be performed by 10,30,60 or 180 days), cancellation of the request, cancellation of the original request with programming of different performance. At the end of the consultation, the Gastroenterologist filled the Polaris record with the final decision, this determined the appropriate action the cancellation of the request or the issuance of a new request for the same or for another service according to the agreed priority. The requests issued were sent to a reservation centre, who contacted the patient to arrange an appointment. At the same time, the GP and the patient, received a summary letter about the interview. Results: A total of 1097 requests were handled. The E-GPack has affected the remodulation of performance with a reduction of 20% for consultations, 22% Colonoscopies and 24% EGDS. Thus, after reevaluation, 853 requests (31% consultations, 38% EGDS, 59% colonoscopies) were programmed (20% with priority of 10 days, 36% of 30 days, 30% of 60 days, 14% of 180 days). Conclusions: E-Gpack has allowed to spread the peak of requests in a period up to 180 days, lowering the peak supply requirement for recovery and creating the conditions for the crossover activation of room available to new accesses.