Are German endoscopy units prepared for the COVID-19 pandemic? A nationwide survey
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Abstract
Objective
The COVID-19 pandemic challenges health care systems worldwide. In this situation, guidelines for health care professionals in endoscopy units with increased risk of infection from inhalation of airborne droplets, conjunctival contact and faeces are urgently needed. Recently, the European Society of Gastrointestinal Endoscopy (ESGE) and the German Society for Pneumology (DGP) issued recommendations. However, real-world data on the conditions and requirements of endoscopy units to adhere to this guidance are missing.
Design
We conducted an internet-based survey among German endoscopy units from all levels of care from April 1 st to 7 th , 2020. The survey comprised 33 questions and was distributed electronically by the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) and the DGP.
Results
In total, 656 endoscopy units completed the survey. Overall, 253 units (39%) cancelled fewer than 40% of their procedures. Of note, private practices cancelled less procedures than hospital-based units. Complete separation of high-risk and COVID-19 positive patients was achieved in only 20% of the units. Procedural measures were well adopted, with 91% of the units systematically identifying patients at risk and 85% using risk-adapted personal protective equipment (PPE). For the future, shortages in PPE (81%), staff (69%) and relevant financial losses (77%) were expected.
Conclusion
Concise definitions of non-urgent, elective interventions and endoscopic surveillance strategies are needed to better guide endoscopic activity and intervention cancellations. In the short term, a lack of PPE can constitute considerable impairment of endoscopy units’ operability and patient outcomes.
SUMMARY BOX
What is already known about this subject?
Recent data indicate a potentially important role of the gastrointestinal tract in the spreading of COVID-19.
Endoscopy units and their personnel are at high risk to be exposed to and to distribute COVID-19 infections.
Several societies have formulated guidance for endoscopy units in the current situation, but their feasibility is unclear.
What are the new findings?
Endoscopic activity seems not to be limited to urgent interventions across all units as 39% of all endoscopy units cancelled less than 40% of procedures.
For most endoscopy units, structural conditions are insufficient to realize a complete separation of high-risk patients, which can be guaranteed by only 20% of the units.
The willingness to adhere to the recommendations is very high, as most endoscopy units adopted their procedures accordingly. Shortage of personal protective equipment is a critical concern in many units.
How might it impact on clinical practice in the foreseeable future?
An update of the current recommendations to refine practicable measures for the majority of endoscopic units is warranted.
A concise definition of non-urgent or elective procedures as well as postponement strategies and intervals are of utmost importance, since current data implicate that transmission of SARS-CoV-2 via the respiratory and gastrointestinal tract may be critical for public health.
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SciScore for 10.1101/2020.04.19.20071340: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IACUC: Ethical approval was obtained from the local ethical review committee (Title: “Versorgungsrealität in deutschen Endoskopiezentren in Zeiten der COVID-19-Pandemie”; 2020-044; March 30th, 2020). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Descriptive statistics were calculated using Office Excel 2016 (Microsoft Corporation, Redmond, US). Office Excelsuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results…SciScore for 10.1101/2020.04.19.20071340: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IACUC: Ethical approval was obtained from the local ethical review committee (Title: “Versorgungsrealität in deutschen Endoskopiezentren in Zeiten der COVID-19-Pandemie”; 2020-044; March 30th, 2020). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Descriptive statistics were calculated using Office Excel 2016 (Microsoft Corporation, Redmond, US). Office Excelsuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths & limitations: Since there are no absolute numbers for endoscopic units in Germany available, we cannot calculate the exact response rate of our survey. For GI units in hospitals a rough estimate can be made using intervention numbers from responses and published GI intervention numbers of inpatients [18]. With this data we estimated that between 30 to 50% of hospitals with a GI endoscopy unit answered our survey. Furthermore, our responses are well distributed throughout Germany indicating representativeness. Lastly, the short survey timeframe allowed for a concise snapshot of the situation in a phase of rising case numbers and uncertainty. Our study was limited to Germany as the COVID-19 pandemic was in a relatively uniform state during the survey. Otherwise, this limitation implies that the transferability of some results to other health care systems and countries may not be possible. Finally, the survey offered participants the possibility to remain anonymous. Where postal codes were given, we were able to discard duplicates, however, as 22.1% of the responders did not provide their postal codes a certain bias cannot be excluded with certainty.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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