AFTER COVID-19: GUIDELINES FOR RE-OPENING AN ENDOSCOPY SUITE

BY

DR. CHERYL ANDERSON, DEGREE, COMMITTEE CHAIR

CARMEN MCDONALD, DEGREE, COMMITTEE MEMBER

FACULTY NAME ALL CAPS, DEGREE, COMMITTEE MEMBER

SCHOOL OF BUSINESS, TECHNOLOGY, AND HEALTH CARE ADMINISTRATION

A CAPSTONE PROJECT PRESENTED IN PARTIAL FULFILLMENT

OF THE REQUIREMENTS FOR THE DEGREE

DOCTOR OF HEALTH ADMINISTRATION

MONTH YEAR:
 Executive Summary

The global impact of the COVID-19 pandemic on endoscopy services has been severe,

since people and real estate have been repurposed. As the recovery process begins from the

pandemic, a coordinated worldwide response is required, as well as guidelines on how to

properly resume endoscopic services to minimize unintended consequences from diagnostic

delays. The purpose of these study is to offer doctors with consensus advice for resuming

endoscopy services quickly and safely. An evidence-based literature evaluation was conducted

on the various tactics utilized around the world to manage endoscopy and control infection

during the COVID-19 pandemic. Decreasing missed appointment percentages can increase

clinical utilization and efficiency, eliminate waste, enhance satisfaction, and result in better

health care experiences, according to research. Missed appointment rates in patient care

globally range from 10% to 50%, with an average rate of 27% in North America. The statements

were divided into three categories: pre-endoscopy, during endoscopy, and post-endoscopy, and

they addressed important areas of practice such as personal protective equipment,

screening, appropriate endoscopy surroundings, and infection control precautions, especially in

areas where disease prevalence is high. The recommendations for patient and healthcare worker

testing, suitable donning and doffing regions, and social distancing measures prior to endoscopy

are unique and not covered by any other standards.

 Dedication

This research is dedicated to my family and many friends. I owe a special debt of

appreciation to my devoted parents, whose words of encouragement and insistence on

perseverance still sing in my ears. My sisters are very dear to me and have never left my side.

This study is also dedicated to my numerous friends and church family who have helped me

along the way. I shall be eternally grateful for everything they have done for me, particularly for

assisting me in honing my technological talents.

iii
 Acknowledgments

I'd like to express my heartfelt gratitude to my teacher and our principal for providing me

with the wonderful opportunity to do this wonderful project on the topic (after covid-19:

guidelines for re-opening an endoscopy suite), which also allowed me to do a lot of research and

learn a lot of new things. I'm truly grateful to them. Second, I'd like to express my gratitude to

my parents and friends for their assistance in completing this project within the time constraints.
Table of Contents

List of Tables................................................................................................................................viii

List of Figures.................................................................................................................................ix

SECTION 1. HEALTH ADMINISTRATION PROBLEM AND PROJECT SCOPE...................1

1.1 Introduction................................................................................................................................1

1.2 Capstone Topic..........................................................................................................................3

1.2.1 Problem of Practice...........................................................................................................3

1.3 Purpose of the Project................................................................................................................4

1.3.1. Project Need.....................................................................................................................4

1.3.2 Project Question(s)............................................................................................................5

1.3.3. Project Justification..........................................................................................................5

1.3.4 Project Context: Company or Industry.............................................................................6

1.3.5 Terms and Definitions.......................................................................................................6

1.4. Doctor of Business Project Specifications................................................................................6

1.4.1. Importance of the Project.................................................................................................6

1.4.2. Approach for the Project..................................................................................................7

1.5 Summary....................................................................................................................................7

SECTION 2. LITERATURE REVIEW AND PROJECT PLAN...................................................8

2.1. Introduction...............................................................................................................................8

2.1.1. Applied Framework........................................................................................................8

2.2. Method for Discovering Literature...........................................................................................9

2.2.1. Inclusion and Exclusion Criteria......................................................................................9

2.2.2. Search Strategy..............................................................................................................10

2.3. Review of Scholarly and Practitioner Literature....................................................................11

2.3.1. Historic and Current Business Problem Trends.............................................................11

2.3.2. Previous Efforts to Address the Problem......................................................................11

2.4. Summary of Literature............................................................................................................11

2.5. Recruitment.............................................................................................................................16

2.6. Project Study Protocol............................................................................................................17

2.6.1 Data Sources...................................................................................................................17

2.6.2. Data Collection..............................................................................................................18

2.6.3. Data Analysis Plan and Presentation.............................................................................18

2.6.4 Validity and Reliability/Trustworthiness........................................................................18

2.6.5 Ethical Considerations....................................................................................................18

2.7. Overview of the Project Study Plan........................................................................................18

2.8 Summary and Conclusion........................................................................................................18

SECTION 3. RESULTS, DISUSSION, AND IMPLICATIONS.................................................20

3.1 Introduction..............................................................................................................................20

3.2. Data Collection Results...........................................................................................................20

3.3. Data Analysis..........................................................................................................................20

3.4 Contribution to Theory, the Literature, and the Practitioner Knowledge Base.......................20

3.5 Project Application and Recommendations.............................................................................21

3.6 Conclusion...............................................................................................................................21

REFERENCES..............................................................................................................................22

APPENDIX A. APPENDIX TITLE..............................................................................................27

PUBLISHING AGREEMENT......................................................................................................52
STATEMENT OF ORIGINAL WORK........................................................................................54
 LIST OF TABLES

Table 1. Table Title: Example of a Capella APA Table, Section 3

 LIST OF FIGURES

Figure 1. Figure Title [Example of a Capella APA Figure], Section 3

 SECTION 1. HEALTH ADMINISTRATION PROBLEM AND PROJECT SCOPE

1.1 Introduction

The novel coronavirus SARS-CoV-2 is extremely contagious and is mostly transmitted

via droplets produced from the upper respiratory tract. Endoscopy is an aerosol-generating

operation (AGP) that has the potential to transmit illness, putting both HCPs and patients at risk.

As a result, most national organizations issued guidelines on how to enhance endoscopy safety

during the epidemic. COVID 19 impacted health care and medical practices throughout the

world. Gastrointestinal (GI) clinical practices were impacted in multiple ways with the virus.

Initial plans for most outpatient clinics included cancelation of appointments, outpatient

procedures, and elective surgeries (Telford et al., 2019).

Additionally, GI clinics treat patients with Ulcerative Colitis, Inflammatory Bowel Disease and

Crohn’s Disease (Castagna et al., 2021). The intense focus on mitigation and infection

control measures during this crisis has left major health care requirements unmet, with the

potential harmful implications of extended delays in treatment. The causes of these delays

include the widespread closure of medical offices, the cancellation of non-emergent treatments,

and the loss of health insurance by millions of people. Patients with chronic illness were

adequately and successfully managed prior to the pandemic (Danese et al., 2020). However, once

the clinic closure took place, a few patients reported experiencing new and uncontrolled

symptoms due to the lack of diagnostic care and treatment. COVID-19 is the unwanted guest that

refuses to depart for certain patients. Insomnia, tiredness, changes in taste and smell, shortness of

breath, palpitations, dizziness, chest discomfort, anxiety, and sadness are among the symptoms

reported by these survivors. In other instances, the symptoms are incapacitating, prohibiting

people from working or simply going about their everyday lives. The focus of this capstone
project was to create a formalized, implementation strategy to reopen the clinic and to match

opening with public health needs, mandates, and local laws.

For this to be successfully accomplished, there must be a phased implementation, taking into

account new practices that help to prevent a “re-bending” of the COVID-19 curve, as well as the

implementation of the formal recommendations put forth by the Joint Society (Singh & Day,

2020).

There are no current studies outlining the long-term impact of what the reduction of endoscopic

capacity will have on patients’ condition and associated health, or functional capacity and

adverse effects on prognosis.

As the understanding the pandemic is realized in healthcare, contingency planning for

maintaining continuity of care in a world living with COVID-19 is necessary to prevent longer

term consequences such as GI-related illnesses, mortality, and unmanaged chronic conditions

leading to adverse health events.

The intended goals for this capstone project will be:

1. Create a triaging process that categorizes urgent, semi-urgent and non-urgent patients based on

patient risk factors per the guidelines and recommendations set forth by state and federal

agencies to determine its efficiency and

2. Develop a pre- appointment COVID-19 screening process and recommendations for a

patient’s care based on their screening results.

3. Analyze the effectiveness of the Joint Society’s recommendations: When severe or increasing

neurologic impairments are present, or significant underlying diseases are suspected based on
history and physical examination, clinicians should conduct diagnostic imaging and testing for

individuals with low back pain.

1.2 Capstone Topic

1.2.1 Problem of Practice

An endoscopy suite, like many other crucial medical processes, is a complex operation whereby

missed and cancelled appointments affect the healthcare industry directly, with a large impact on

patient care.

The World Health Organization declared COVID-19 a pandemic in March 2020. (Doktorchik et

al., 2020). The pandemic caused a proliferation of cancelled appointments for the GI clinic. The

decision to cancel was made by the patient or the physician’s office. The clinic canceled

appointments to mitigate the risk of transmitting the virus to healthcare personnel. All elective

and preventive health visits were immediately cancelled (Fiori et al., 2020). Practices were

forced to close due to health care restrictions (Francisco et al., 2021).

The limitation to this approach was that more serious cases may not be seen in time to prevent

irreversible harm, or patients with milder symptoms may be overlooked. Therefore, it is

extremely crucial that a detailed triaging protocol be created to successfully identify urgent

cases, semi-urgent cases, and non-urgent cases (Telford, et al; 2019).

Multiple questions were raised regarding the gastrointestinal and liver manifestations of COVID-

19 infection, and implications of SARS-CoV-2 infection on gastrointestinal endoscopy. A joint

society statement of the American Gastroenterological Association (AGA), the American

Association for the Study of Liver Diseases (AASLD), the American College of
Gastroenterology (ACG), and the American Society for Gastrointestinal Endoscopy (ASGE)

highlighted the potential for SARS-CoV-2 transmission through droplets, an established mode of

transmission, and possibly fecal shedding, appropriate PPE that should be used during specific

procedures and the associated risk for transmission to endoscopy personnel during

gastrointestinal endoscopy procedures.

These formalized recommendations were created as a guidance document for endoscopic

practices seeking to re-open in a safe working environment.

1.3 Purpose of the Project

1.3.1. Project Need

The purpose of this capstone project is to create a guideline that every endoscopy facility must

provide a safe environment for both patients and employees. Adherence to the current guideline

intervals proved to improve patient outcomes, reduce the risk of harm and improves resource

utilization. Additionally, missed and cancelled appointments have not only financially impacted

the healthcare industry but leads to the potential for adverse patient outcomes. Patients who are

screened at regular intervals or have a pre-defined surveillance schedule, exponentially reduce

their risk for GI-related symptoms. Research has shown that lowering missed appointment rates

can improve clinical efficiency and utilization, reduce waste, improve provider satisfaction and

lead to better health outcomes for patients. Missed appointment rates range from 10% to 50%

across healthcare settings in the world with an average rate of 27% in North America. Patients

with higher missed appointment rates are significantly more likely to have incomplete preventive

cancer screenings, worse chronic disease control and increased rates of acute care utilization

(Mohammadi, et al., 2018). It is crucial that a detailed triaging protocol is created as part of the

rescheduling process to successfully identify urgent cases, semi-urgent cases and non-urgent
cases (Telford, et al; 2019). It is also imperative that physicians and healthcare personnel utilize

the correct PPE during endoscopic procedures that were highlighted within the formal

recommendations. Regardless if the patient missed the appointment or the clinic cancelled,

patients are more likely to have poor chronic disease control and increased use of Emergency

Department services.

1.3.2 Project Question(s)

PQ1: How do COVID-19 implementation practices affect a San Francisco, CA practice in terms

of rescheduling cancelled appointments and the accurate use of Personal Protective Equipment

(PPE) for endoscopy procedures, according to the American Gastroenterological Association?

1.3.3. Project Justification

As GI practices and Advanced Surgical Centers begin the initial stages in the process of re-

opening their facilities and re-hiring their work staff, the American Gastroenterological

Association seeks to provide the guidance required to make the process successful.

The Joint Society created a guidance document that summarizes the data and provide evidence-

based recommendation and clinical guidance. This rapid recommendation document was

commissioned and approved by the AGA Institute Clinical Guidelines Committee (CGC), AGA

Institute Clinical Practice Updates Committee (CPUC), and the AGA Governing Board to

provide timely, methodologically rigorous guidance on a topic of high clinical importance to the

AGA membership and the public.

These guidelines are not intended to impose a standard of care for individual institutions,

healthcare systems or countries. They provide the basis for rational informed decisions for

patients, parents, clinicians, and other health care professionals in the setting of a pandemic.
As a result of the COVID-19 pandemic, patients who require regular interval

screening procedures as well as those patients who are under a routine screening regimen cannot

receive necessary procedures to help detect and prevent colorectal cancer.  Furthermore, those

patients who are immunosuppressed and/or require routine visits with their healthcare provider

are unable to access treatment thereby requiring patients to seek treatment at emergency

rooms and overwhelming the emergency providers who are responding to the COVID-19 crisis.

This proposal aims to develop a roadmap to assist GI practices on the accurate and appropriate

use of PPE for endoscopic procedures, to develop a triaging process that will assist practices in

identifying their most severe patient cases and render the appropriate treatment.

1.3.4 Project Context: Company or Industry

1.3.5 Terms and Definitions

1.4. Doctor of Business Project Specifications

1.4.1. Importance of the Project

The success of the project will be determined by the development of a patient screening pathway

based on the patient’s risk factors, the development of recommendations for testing, and the

efficient implementation of the joint society’s recommendations. Providers that use the guidance

resulting from this project can be evaluated by the success in the rescheduling process, the

completion of procedures in concordance with the guidance provided as well as adherence to

safety protocols monitored by reports of no work acquired transmission of COVID-19 among

healthcare staff.

Given the proliferation of testing modalities for COVID-19 that result from between 15 minutes

to 5 days, providers are unable to determine which tests should be used in conjunction with their
workflow process. A review of the various available testing modalities will allow for providers

to make a determination of the cut-off values needed to safely allow a patient into a clinic for

his/her procedure and whether patients should be tested for active infection or antibodies. Given

that COVID-19 can be passed to other hosts via fecal transmission, determining the cut-off

values needed to not place a provider at risk is integral to the workflow process. The results and

recommendations will inform the appropriate patient testing schedule and workflow process.

1.4.2. Approach for the Project

1.5 Summary
 SECTION 2. LITERATURE REVIEW AND PROJECT PLAN

2.1. Introduction

2.1.1. Applied Framework

This theoretical framework objectively provides a guide for EU and gastroenterologists with

proper measures to resume endoscopic activities after COVID-19. According to the WHO, there

is a need for physical distancing measures and restriction of contacts in the clinical centers

during and after the pandemic (Srinivasan et al., 2020). Therefore, the decision on resumption of

the EU’s operations should be based on such a critical factor. The decision to reopen the EUs

must be based on other equally significant external and internal factors that will be the unit’s

core responsibility (Vanella et al., 2020; Danese et al., 2020). For instance, during an incremental

phase in the EU to conduct more procedures, there needs to be an adequate period created to

define, measure, evaluate, and reassess the risks of the ongoing EU procedures (Cennamo et al.,

2020). Each step during reopening should be conducted with a realistic set of objectives.

Since the study aims to protect both patients and staff from the transmission of COVID-19 in the

clinical facilities, this theoretical framework offers the basis for achieving this objective and

others. Besides, this framework helps in answering the PICOT question concerns on effective

implementation practices in the EU. Specifically, emphasis is placed on epidemiologic factors,

system capacity, and EU-related factors.

For instance, some of the variables to this study include the effectiveness of containment and

protective measures, identifying vulnerable patients, EU space to implement physical distance

practices, availability of equipment and medication, the priority of endoscopic procedures, and

scheduling and canceling of appointments. Protective and containment measures focus on the

need to limit COVID-19 transmission between patients and staff. Identifying vulnerable patients
helps in strengthening protection measures to avoid exposing them to more risks as a

fundamental element in scheduling and cancelling appointments (Stollman & Kefalas, 2021).

Space plays an essential role in eliminating congestion. Notably, the availability of EU

equipment focuses on the uses of PPEs. Besides, prioritizing cases helps in giving care to

patients with the most needs.

The key assumptions of this study include:

 In the EU with access to COVID-19 testing and limited PPEs, systematic testing before

procedures lowers the risk of virus transmission in the care center.

 In the EU with limited COVID-19 and surplus of PPEs, systematic screening before

endoscopy procedures would be essential to facilitate measures, such as effective

protection of both patients and staff.

 In the EU with limited access to both COVID-19 testing and PPEs, there is a need to

restrict endoscopy procedures to solely high-priority cases until more pieces of

equipment are available.

2.2. Method for Discovering Literature

2.2.1. Inclusion and Exclusion Criteria

Inclusion

The article must be a peer-reviewed journal. Peer-reviewed journals are expert-written and

reviewed before publishing thus are scientifically valid and offer quality evidence from the

conclusions.

The article must be published from 2020 to 2021. The inclusion date ensures that recent

evidence-based studies are utilized in this project.

The article must be written in English, accessible, and relevant to the research. English-written

articles are accurate and prevent time-consuming translation.

The article must be related to gastroenterology and after COVID-19 topics.

Exclusion

Articles that are not peer-reviewed.

Low-quality articles and journals dated earlier than December 2019. Older articles are outdated

and do not address COVID-19.

Journals are irrelevant and written in a non-English language.

Articles Retained

A total of 130 articles were retrieved during the literature search. 50 studies were reviewed and

only 20 studies (n=20) met the inclusion criteria. Other studies were irrelevant to the study and

discarded. The abstracts and the titles of the journals in the search results were evaluated to

determine the relevance of each article. In the next phase, an evidence table was created to

extract data.

2.2.2. Search Strategy

This project uses a systematic review process. A systematic review works best for the project

because it provides a higher quality of evidence beyond the primary research based on reliability,

design, and reproducibility. To achieve more credibility of results, the systematic literature

search will focus on peer-reviewed journal articles.

The search for literature concerning the research question was conducted from PubMed,

EBSCOhost, and PsycINFO databases. PubMed offers access to millions of medical articles and

life science journals, including links to full-text articles and related sources. EBSCOhost offers
access to education topics related to healthcare. PsycINFO contains abstracts and bibliographic

citations on psychology and related topics, such as nursing, medicine, education, and psychiatry.

Each database offers special features, such as search expanders and limiters, which were useful

to the research process. Besides, most of the journals in these databases are indexed using Mesh

terms (a comprehensive controlled vocabulary to enhance searching). Besides, the databases

offer Boolean search terms, “and” and “or” which were crucial in extending and narrowing the

searches to get the relevant research articles. The literature search was limited to peer-reviewed

articles and the date was limited to 2020 – 2021. The key search terms and phrases included

“Endoscopy units,” “COVID-19 impact on Gastroenterology services,” “Guidelines for re-

opening endoscopy services,” and “After COVID-19 and re-opening endoscopy services.”

2.3. Review of Scholarly and Practitioner Literature

2.3.1. Historic and Current Business Problem Trends

2.3.1.1. Potential Additional Section Header.

2.3.1.1.2. Potential Additional Section Header. [Text starts here].

2.3.2. Previous Efforts to Address the Problem

There have been no previous attempts to address this issue.

2.4. Summary of Literature

Search Process

This project uses a systematic review process. A systematic review works best for the project

because it provides a higher quality of evidence beyond the primary research based on reliability,
design, and reproducibility. To achieve more credibility of results, the systematic literature

search will focus on peer-reviewed journal articles.

The search for literature concerning the research question was conducted from PubMed,

EBSCOhost, and PsycINFO databases. PubMed offers access to millions of medical articles and

life science journals, including links to full-text articles and related sources. EBSCOhost offers

access to education topics related to healthcare. PsycINFO contains abstracts and bibliographic

citations on psychology and related topics, such as nursing, medicine, education, and psychiatry.

Each database offers special features, such as search expanders and limiters, which were useful

to the research process. Besides, most of the journals in these databases are indexed using Mesh

terms (a comprehensive controlled vocabulary to enhance searching). Besides, the databases

offer Boolean search terms, “and” and “or” which were crucial in extending and narrowing the

searches to get the relevant research articles. The literature search was limited to peer-reviewed

articles and the date was limited to 2020 – 2021. The key search terms and phrases included

“Endoscopy units,” “COVID-19 impact on Gastroenterology services,” “Guidelines for re-

opening endoscopy services,” and “After COVID-19 and re-opening endoscopy services.”

Inclusion and Exclusion criteria

Inclusion

The article must be a peer-reviewed journal. Peer-reviewed journals are expert-written and

reviewed before publishing thus are scientifically valid and offer quality evidence from the

conclusions.
The article must be published from 2020 to 2021. The inclusion date ensures that recent

evidence-based studies are utilized in this project.

The article must be written in English, accessible, and relevant to the research. English-written

articles are accurate and prevent time-consuming translation.

The article must be related to gastroenterology and after COVID-19 topics.

Exclusion

Articles that are not peer-reviewed.

Low-quality articles and journals dated earlier than December 2019. Older articles are outdated

and do not address COVID-19.

Journals are irrelevant and written in a non-English language.

Articles Retained

A total of 130 articles were retrieved during the literature search. 50 studies were reviewed and

only 20 studies (n=20) met the inclusion criteria. Other studies were irrelevant to the study and

discarded. The abstracts and the titles of the journals in the search results were evaluated to

determine the relevance of each article. In the next phase, an evidence table was created to

extract data.

Synthesis of Literature (For Table, see Appendix A)

Elli et al. (2020) offer a quick reference guide to endoscopists to adapt services and activities to

curb COVID-19 emergencies and prepare them for risks. According to the article, all patients

need to be issued with supplies and surgical masks and perform hand hygiene when entering the

EU. Fiori et al. (2020) add that gastroenterologists must wear disposable and recommended PPEs

and dispose of them after each procedure. Importantly, all EUs must reorganize their rooms to

avoid viral transmission. Hennessy et al. (2020) provide a framework for use in the EU before
and during procedures. Before a procedure, patients need to undergo a pre-visit COVID-19

screening along with a check-in plan (Zhao et al., 2020). During the GI procedures, there is need

for a pre-operative and post-operative room processes, such as creating sufficient room to avoid

overcrowding. During procedures, all endoscopy team members must wear a full PPE set.

Peery et al. (2020) outline who to let in, how and whom to let in the EU first. For instance,

reducing risks of COVID-19 transmission involves limiting the EU to the patients only. The

patient’s family can be informed through videoconferencing or phone calls as they wait away

from the EU. Also, the endoscopy suite must be made more COVID-19 resistant through

thorough decontamination procedures that focus on disinfecting and cleaning high-touch areas.

Besides, Guda et al. (2020) suggest that an effective approach to protect gastroenterologists

includes creating adequate space in the clinical facilities, regular screening of EU team members,

always using PPEs, conducting pre- and post-checkups on patients. Importantly, the EU must be

cleaned after each procedure and disinfected before another procedure.

Machicado et al. (2020) address the need for a proper intra-procedural process that incorporates

effective PPEs use. It includes using waterproof gowns, universal fit-tested respirators, long-

sleeve shoe covers, and double pair of gloves. Importantly, there is a need to establish a

consistent supply chain of PPEs, devices, equipment, cleaning products, and aesthesia

medications before reopening and during endoscopic procedures. According to Das (2020), other

operational indicators are essential after the reopening of the EU after COVID-19. These include

an increased facility time, such as waiting room time and waiting for preoperative bays, and a

decrease in the number of physicians. These indicators ensure strict measures are in place to

prevent COVID-19 transmission within the EU.

Sharma and Dutta (2020) reveal the implications of COVID-19 among gastroenterologists.

Therefore, the authors call for strict practices in the EU settings, such as cleaning using UV light,

restarting endoscopy gradually through different phases, and mandatory effective use of PPEs

and discarding after each procedure. Besides, training GI residents is essential to protecting

teams in the EU. Niriella et al. (2020) and Ménard et al. (2020) suggest that the very design of

endoscopic instruments based on the parts, valves, and air pressures create the possibility of risks

that generate micro-droplets that increase the chances of endoscopists to contact COVID-19.

Therefore, it is essential to create a better EU setting that limits transmission of the virus among

patients and staff through adopting technological interventions, such as telehealth (Furfaro et al.,

2020). Besides, it is crucial to perform pre-screening among patients to identify symptoms or

exposure to COVID-19.

According to Kriem and Rahhal (2020), the fundamental practice to protect pediatric

endoscopists is through establishing a proper EU setup. In particular, there is a need for the

creation of more zones, endoscopy suites, and negative pressure operating room to decrease

contamination risks. Additionally, Yu et al. (2021) emphasizes the need for proper PPEs use,

thorough room turnover and cleaning, and adoption of elective GI procedures. As such, patients

must be assessed for COVID-19 signs upon entry to the unit, while EU staff should be screened

daily.

Grossberg et al. (2020) outline different recommendations that were issued by the American

society of Gastrointestinal Endoscopy. There is a need for screening of all patients to test for the

virus and a questionnaire filled 72 hours before the procedure. These authors introduce a new

perspective, which is ranking the urgency of patients based on those with severe conditions that

may be more susceptible to COVID-19. According to Fatima and Shin, (2020), such patient
populations must be prioritized. Besides, infusion suite services need to be maintained at every

EU.

Zhang et al. (2020) and Bleier et al. (2021) note that it is important for every EU to establish

standard infection control criteria that rely on the academic society guidelines and national

guidance while tailoring them to the center’s individual needs. Some essential guidelines include

admission control and procedures triage. Gralnek et al. (2020) suggest admission control

prevents unnecessary contacts while procedures triage helps categorize cases (as semi-urgent,

urgent, elective) to help prioritize GI cases. According to Castagna et al. (2020), the

implementation of a triage system in the EU before the resumption of operations is essential.

Specifically, an elective outpatient endoscopy routine is necessary as well as recognizing that the

volume of outpatient cases must be reduced.

Importance of the Study in Filling-in Gaps, Validating, or Testing Knowledge

Endoscopy units that resumed operations during the pandemic have been forced to shut down

due to an increase in the number of COVID-19 cases. The current procedures that are put in

place are ineffective due to inconsistency in most EU environments. The existing measures work

to mainly protect the patients and not the care providers. This study presents additional measures

that can be utilized in the EU to help protect both patients and gastroenterologists. A major

emphasis is placed on the need to protect the clinical staff because they are frontline healthcare

workers who have been forgotten. COVID-19 national and local guidelines need additional

recommendations for the Gastroenterology Organizations. These measures are essential for the

reopening of the EU after COVID-19 to help protect gastroenterologists.

2.5. Recruitment

The participants will come from San Francisco Gastroenterology unit. There will be a total of 10

participants, forming two groups of 5 experts each.

Inclusion Criteria

 Must be a certified gastroenterologist. Certified experts offer quality insights into the

research.

 Practiced for more than 3 years. Experience creates a more critical approach to the

research.

 Must have worked in the COVID-19 environment. Such staff has observed guidelines

and practices.

 Must be COVID-19 negative. Due to the focus group meetings being conducted face-to-

face, participants must be virus-free.

Exclusion Criteria

 COVID-19 positive.

 Have not worked in the COVID-19 setting before.

 Unregistered gastroenterologist.

 Between 1 – 2 years of practice.

Sample Recruitment Process

The first step in this recruitment process is determining how to reach the participants. Due to the

closure of the facility, it is essential to call the office and get information concerning the staff.

The next step is establishing the screening criteria based on the inclusion and exclusion

procedures. Only 10 most qualified participants are targeted. The last step is placing

confirmation email, texts, and calls through the obtained contact information.
Besides, these participants will be protected through:

 Acquiring the informed and voluntary consent before the focused group meetings.

 Providing sufficient protection of their privacy and maintaining data confidentiality.

 Adequate training of the participants before conducting the meetings.

2.6. Project Study Protocol

2.6.1 Data Sources

2.6.1.1. Preliminary Sources of Data Expected.

2.6.1.2. Instrumentation and Data Collection Tools.

2.6.2. Data Collection

Data will be collected through a focus group. A focused group is essential for this study because

it engages the participants (gastroenterologists) in a useful discussion (Tritter & Landstad, 2020)

concerning the topic of reopening the EU after COVID-19. They are experts in this area and their

input is useful towards gathering useful data for the research.

With the focus group, data will be evaluated through a moderator, whose role is to introduce new

ideas to the groups and inspire new ways of thinking by the participants.

2.6.3. Data Analysis Plan and Presentation

2.6.4 Validity and Reliability/Trustworthiness

2.6.5 Ethical Considerations

Participants will be protected through:

 Acquiring the informed and voluntary consent before the focused group meetings.

 Providing sufficient protection of their privacy and maintaining data confidentiality.

 Adequate training of the participants before conducting the meetings.

2.7. Overview of the Project Study Plan

2.8 Summary and Conclusion

To summarize, a strong leadership team should be established as a priority in order to

financially successful in restarting and scaling up endoscopic services. Communication

frequency and flexibility of personnel and providers are critical. It is crucial to schedule the

correct patient at the proper time. Supply availability could be a rate-limiting phase. Paying close

attention to the difficulties highlighted might increase the likelihood of success when restarting

or scaling up an endoscopic unit or center.

 SECTION 3. RESULTS, DISUSSION, AND IMPLICATIONS

3.1 Introduction

3.2. Data Collection Results

3.3. Data Analysis

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Items Counts
Item 1 4

Item 2 6

Item 3 21

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template.

3.4 Contribution to Theory, the Literature, and the Practitioner Knowledge Base

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D H A
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without permission. Typically, this note would include the copyright and permissions

information for a figure, unless created by the research author, in which case, the note should

state that the work was research author created. See APA 7 th edition, Rule 7.7 (p. 198) and all

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before using the template.

3.5 Project Application and Recommendations

3.6 Conclusion
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 APPENDIX A. APPENDIX TITLE

Please include all instruments, permissions, and other important documentation here [as

determined by your instructor, mentor, or committee members] until final Dean review, at which

time they should be removed. Learner-created interview protocols, surveys, or other original

documentation should remain for Dean review and final submission.

Major
Conceptua
Variables Appraisal:
l Design/ Sample/ Measurem Data
Citation Studied and Findings Worth to
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their Practice
k
Definitions
Elli et al. N/A N/A N/A N/A N/A N/A Effective Strength:

(2020) manageme Gives

nt of effective

personnel recommend

and patients ation on

reduces guidelines

more health to re-

risks. opening

These endoscopy

include after

space COVID-19
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l Design/ Sample/ Measurem Data
Citation Studied and Findings Worth to
Framewor Method Setting ent Analysis
their Practice
k
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manageme pandemic.

nt, effective Weakness:

scheduling, N/A

and

duration Rank=

processes. High

Use

interventio

ns, such as

video-

capsule

endoscopy.
Hennessy N/A N/A N/A N/A N/A N/A The top Strengths:

et al. priority for outlines

(2020) patients and different

staffs recommend

include ations to

Screening protect

procedures clinical
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for patients staff and

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protecting outlined

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clinical works

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Citation Studied and Findings Worth to
Framewor Method Setting ent Analysis
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k
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ce endoscopy staff and Weakness:

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Rank =

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Sharma & N/A N/A N/A N/A N/A N/A COVID-19 Strength:

Dutta has Important

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Variables Appraisal:
l Design/ Sample/ Measurem Data
Citation Studied and Findings Worth to
Framewor Method Setting ent Analysis
their Practice
k
Definitions
(2020) increased insights on

healthcare the effects

risks for of COVID-

gastroenter 19 effects

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them is ologists

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in healthcare

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the safety

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Citation Studied and Findings Worth to
Framewor Method Setting ent Analysis
their Practice
k
Definitions
adjustments

to the EU

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The following standards for original work and definition of plagiarism are discussed in the

Policy:

Learners are expected to be the sole authors of their work and to acknowledge the authorship of

others’ work through proper citation and reference. Use of another person’s ideas, including

another learner’s, without proper reference or citation constitutes plagiarism and academic

dishonesty and is prohibited conduct. (p. 1)

Plagiarism is one example of academic dishonesty. Plagiarism is presenting someone

else’s ideas or work as your own. Plagiarism also includes copying verbatim or
rephrasing ideas without properly acknowledging the source by author, date, and
publication medium. (p. 2)

Capella University’s Research Misconduct Policy (3.03.06) holds learners accountable for

research integrity. What constitutes research misconduct is discussed in the Policy:

Research misconduct includes but is not limited to falsification, fabrication, plagiarism,

misappropriation, or other practices that seriously deviate from those that are commonly
accepted within the academic community for proposing, conducting, or reviewing
research, or in reporting research results. (p. 1)

Learners failing to abide by these policies are subject to consequences, including but not limited

to dismissal or revocation of the degree.

Acknowledgments:

I have read, understand and agree to this Capella Publishing Agreement. I have read, understood,

and abided by Capella University’s Academic Honesty Policy (3.01.01) and Research

Misconduct Policy (3.03.06).

I attest that this dissertation or capstone project is my own work. Where I have used the ideas or

words of others, I have paraphrased, summarized, or used direct quotes following the guidelines

set forth in the APA Publication Manual.

(Print Name)

REQUIRED Author's signature Date

(by typing your name, you agree that this is your signature).