So, to move on, we'll start with another polling question. If you can turn back time and go back to March of 2020, terrifying proposition, I know. But looking back, what would you have done differently? Right sizing of your staff, be prepared for your PPE requirements, communication of your patients needed to be more streamlined, or it's a communication with your staff members. And the answers are interesting. Communication with the staff members. That's fascinating. It's actually an interesting split across all four items. But the dominant issue is better communication with your team. And I can see that that can take care of all the rest of the issues, that communication better internally would lead with the better communication with your patients, then you can really make appropriate changes in your supplies and the right sizing of your staff. Amazing. We have a very sharp audience here. Thank you. Okay. Let's get going. Hi, my name is Inessa Haykis. I would like to thank ASG and my course co-directors for giving me this opportunity to present to you rethinking emergency management. We won't get caught off guard again. I have no disclosures to report. There is no doubt that the past year and a half presented unique challenges to all of us. But today I would like to focus on five lessons that we can learn from the pandemic on resiliency and strength. We have to be prepared for unexpected. We need to encourage collaboration and a healthy workspace. The renewed focus on work-life balance will be here to stay post-pandemic crisis. And that the businesses, we have to identify our core principles and stay true to them while adjusting to the new normal. And happy employees and patients certainly are the key to getting back to successful practices. Expect the unexpected, easier said than done. The pandemic hit fast and very few businesses had any contingency plan for a global health crisis. When we had to close our offices and surgical centers in March of 2020, there was no way of knowing that we're still dealing with that virus in the second half of 2021. The biggest lesson we learned over the past two years is that we need a scalable and efficient emergency plan. This kind of plan can help avoid practice interruptions and confusion for the employees during the crisis while ensuring continuity of care. For instance, as soon as we realized the tremendous impact that the pandemic would have, we launched our emergency response committee in the office as well as in our endoscopy center to not only make crucial practice decisions, but also to ensure that we effectively communicated with all of our team members. Much like training for fire drills, action plans can be put in place to prepare for future events. Taking what worked and what didn't work in mind while creating this new emergency plan will ensure you are ready to weather any kind of unpredictable event. After all, if you are not ready for everything, you are not ready for anything. Reopening of our offices and centers came with workforce challenges. Our offices and ICs are tasked with keeping our staff and patients safe from COVID-19 exposure. One positive case could cause a domino effect of isolation and quarantine among staff, possibly to an extent necessitating a complete closure. It is our duty to create a healthy workspace while encouraging collaboration. It is very important to maintain open lines of communication so our employees would feel comfortable coming to work. Our employees should still have a sense of privacy and space, both physically and mentally. Make a point to create these spaces for solitude and opportunities for breaks. We had to renew our focus on work-life balance. The pandemic taught us how busy everyone's lives are outside of the office. As our cities begin to lift restrictions, many activities are returning and vacations or weekend trips that fell victim to the pandemic are being rebooked. Remind your team to respect the life they live both inside and outside of work. The sense of community, purpose, and satisfaction they get from being healthcare professionals is an important aspect of doing a good work while delivering great care for our patients. As healthcare professionals, we always have to stay true to our core principles. The physical way you do business may change in light of lessons learned during the pandemic. Entering NIC at the end of 2020 looks much different than it did at the beginning of the year. Additionally, the pandemic affected daily operating room management, particularly for surgical procedures that cause aerosol production. Many of these changes required a greater time, commitment by staff, a greater investment in the single-use supplies that the centers may have originally budgeted for. COVID crisis has triggered the explosion of telehealth. According to Kaiser Permanente, telehealth, whether video or telephone visits, accounted for only 18% of specialty care visits before March 1st of 2020. And in contrast, by the week of April 19th of 2020, they accounted for a whopping 76% of the visits. Although elective procedural volume decreased markedly over this period, urgent and emergent procedural and surgical caseloads, typically accounting for 30-40% procedural or surgical volume, remained stable. This suggests that even during high levels of mitigation or suppression, a combination of telehealth and highly selected office visits can allow the prompt evaluation and scheduling of critical procedures and surgeries, including cancer-related care, despite decreased procedural volumes. We all have to focus on risk stratification to maximize the benefit of what we offer to our patients. The likely benefit of the procedures varies markedly by indication and includes both disease morbidity and mortality. The recent publications for gastrointestinal procedures provide important information regarding patient benefits for the most common indication for colonoscopy, screening, surveillance, follow-up of a positive FIT test, etc. We all have to risk stratify our patients so we can devote our limited resources and attention to individuals that needed our help the most. The high-risk patients included FIT-positive patients who were approaching six months from their tests, after which there were significantly increased risk of disease progression. We had to focus on patients that manifested alarm signs and symptoms, those with dysphagia, unexplained weight loss, evidence of GI bleed, or inflammatory bowel disease flare. We had to attend to patients with lab-test abnormalities suggestive of acute disease, for example, acute or progressive iron deficiency anemia, or abnormal imaging studies, or signs and evidence of obstructive jaundice. We couldn't really keep postponing the procedures for patients with large or incompletely resected polyps much longer. And as always, we have to stay true to our principle, premium non-non-serum. That means we have to assess procedure-related harm during pandemic, which included patient infection risk, medical staff infection risk, as well as procedure-related complications. Given that endoscopic procedures are generally low risk, even among persons with high comorbidities, the risk is primarily related to identification of a disorder amenable to surgery. A relevant indication, for example, evaluation of a colon mass seen on a CAT scan. If such patient is unlikely to tolerate surgery, that patient is less likely to benefit from our endoscopy. To facilitate the safety of our operations, ASG put together a wonderful document, Guidance for GI Endoscopy and Practice Operations During the COVID-19 Pandemic. This document outlines the updated recommendations to employ for the mitigation of infectious risk during continued operations in the endoscopy centers, as well as GI clinics. You'll find making these updates can help inspire a new sense of safety and security. Doing so is also a visible sign to all employees and patients that their needs, safety, and happiness are top priority. Another lesson learned during the pandemic, that happy employees and patients are key to getting back to successful practices. Watching how our practices and ASCs improvised, strategized, and modernized on the fly during the pandemic is a reminder of how resilient we really are. The COVID-19 pandemic crisis has changed how patients seek care and perceive hospitals. This experience accelerated the speed of migration of procedures from the hospital to the ASCs with their lower overhead and high quality patient care. While in the year 2005, only 32% surgeries were done in ASCs, that has increased to nearly 60% in the year 2020, with no signs of stopping. Released in early December, CMS 2021 payment update for ASCs reflected continued payer interest in migrating procedures to the outpatient setting. CMS finalized plans to remove 1,700 procedures from the inpatient only list by 2024. These decisions will further expand opportunities for ASCs where the risk of infection, COVID-19 included, is lower than it is in the hospital, making it an appealing setting for patients who are now more infectious conscious than ever. And here is the takeaway. One of the best lessons we can all learn from the pandemic is a renewed commitment to resiliency. When a practice or ASC and its employees are tested by a worldwide crisis, they collectively learn their strength and the areas in which they can improve. We must all be sure to apply those lessons and come out on the other side of this pandemic stronger. It is through these difficult situations that we find what matters the most in our practices and in our lives. Thank you so much for your attention.

resiliency

emergency management

work-life balance

patient care

ambulatory surgery centers