CPSO IPAC CHECKLIST

April 27, 2020

Dear Members,

We have been getting queries about the performance of endoscopy in OHP’s during this pandemic.
As you are aware, the Ministries of Health and Public Health have recommended that all elective surgical/medical procedures be cancelled.  We appreciate that many of you have temporarily closed your clinic operations at your own personal financial cost, and we thank you for doing this. Our executive agrees that this is the most prudent course of action at present with only emergent procedures being done at this time. We feel that these urgent cases at present would be best performed in the hospital setting.  

Although the executive feels that we should not resume procedures in our out of hospital endoscopy units until community infections are trending downward and the Province has begun to resume procedures and surgeries, we do recognize that each clinic has the independence to choose their own opening date and we are mindful that clinics have symptomatic patients waiting for endoscopy and that there are many endoscopists who do not have hospital privileges.  This letter is intended for guidance as we all start to plan for resumption of services.

Each clinic will have to determine when it is appropriate for them to reopen and when they are prepared to reopen. When the decision to reopen one’s clinic is made, we will still need to be mindful and cautious. Enhanced patient and staff screening, reduced case volumes to allow for adequate patient separation, and triaging and performance of more urgent and symptomatic cases will need to be considered. It is important that we protect our patients, clinic staff, members of the public, and our physicians by ensuring that we have adequate and appropriately worn PPE at our clinics. We endorse the recent CAG guidelines (link below) and feel strongly that it is a duty and obligation that all endoscopy units, despite resource limitations, provide all staff with adequate PPE as suggested by these guidelines if they are to perform endoscopy. Given the fact that gastroscopies are potential aerosol generating procedures, we feel that these should not be performed in an OHP setting, particularly given provincial resource limitations with respect to N95 mask availability and availability of adequate mask fit testing in this setting. 

This statement has been endorsed by the Ontario Association of Gastroenterology and their President, Dr. Rasul. A joint statement with the Ontario Association of Gastroenterology will be distributed in the near future. We hope this forthcoming statement will provide practical guidance to clinics as to principles and processes clinics should consider as they work to develop their plans on how to resume activities safely in these times.

We wish you and your patients good health as we work through these difficult days.

http://cags-accg.ca/wp-content/uploads/2020/03/CAG-Statement-COVID-Endoscopy.pdf

 

Ian Bookman

President, OACE 

OAG/MIG Clinic Endoscopists Executive