DHA CAPSTONE TEMPLATE

DHA CAPSTONE TEMPLATE

The pages in this template are correctly formatted and organized. Refer to the DHA Capstone Template Guide and the Doctoral Publications Guidebook. Replace text as instructed. Sign the honesty and publication agreement immediately. Delete all instructions and template notes before submitting to your instructor, mentor, or committee for reviews. Delete all text in yellow.

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

Capella University

Month Year [of final school approval]

© Copyright 2021 Aminata Page

Instructions

1. Purpose.  The template provides structure and guidance for Capella University learners who enrolled in the School of Business, Technology, and Health Care Administration’s capstone program and began on or after January 1, 2018.  This template may require updates as program requirements change.  You will be notified by the DHA Program Director or Assistant Program Director when a new template is released.  Required content pieces may vary by learner, depending upon their specific topic/project plan.  Consult with your instructor/mentor/chair about potential changes if you think this pertains to you.

2. Rubrics.  Please see the DHA Capstone Template Guide on the DHA Capstone University website to review the rubrics which will be used to grade your work.  Further, the guide includes suggested content for each section.  Not all studies will exactly fit into the template guide suggested content, so work with your instructor/mentor/chair/committee to ensure your project is designed appropriately for the techniques and process you have utilized.

3. Style note.  This template uses APA 7th edition, with some exceptions, including those noted in the  Doctoral Publications Guidebook. First, the template has an executive summary, not an abstract.  The template uses non-APA heading levels, which mirror a business document. Include only sections, and levels 1 and 2 headings in the TOC.  Except for these minor changes (i.e., numbered heading levels), follow APA 7th edition for all other items, in line with Capella Document Publication guidelines for any exceptions.

DELETE ALL INSTRUCTIONS PRIOR TO SUBMISSION FOR REVIEW.

Executive Summary

Write a one to two page executive summary of your project here. This should not be written until the final approvals to your project are completed. This should explain the problem, purpose, method, population, and results of your project. Implications or practical uses of the project results should be included. This is not an APA abstract. This would be used to provide a high-level explanation of your project to a CEO, COO, or other key-stakeholder. Use paragraphs, clear statements, and precise language. Organize this via sections, like this:

1.0. Problem

2.0. Purpose

3.0. Method

4.0. Population

5.0 Results

6.0 Implications/Uses

DELETE THESE INSTRUCTIONS PRIOR TO SUBMISSION FOR ANY REVIEW.

Dedication

This page is optional. The dedication is the writer’s personal acknowledgment indicating his or her appreciation and respect for significant individuals in the writer’s life. The dedication is personal; thus, any individuals named are frequently unrelated to the topic of the manuscript. 

Typically, the learner dedicates the work to the one or two individuals who instilled in the learner the value of education and the drive to succeed in educational pursuits. Learners often dedicate manuscripts to relatives, immediate family, or significant individuals who have supported them or played a role in their lives. 

DELETE ALL INSTRUCTIONS PRIOR TO SUBMITTING FOR REVIEW.

Acknowledgments

The acknowledgments differ from the dedication in one significant way: The acknowledgements recognize individuals who have supported the writer’s scholarly efforts as they relate to the doctoral manuscript or who have held a role in the writer’s academic career as it relates to the research of the manuscript. This might mean your mentor and committee members, doctoral advisor, online or colloquia faculty, and other support people from Capella or other organizations. If you received financial support from fellowships, grants, or other organizational support, it should be noted in this section.

DELETE ALL INSTRUCTIONS PRIOR TO SUBMITTING FOR REVIEW.

Table of Contents

Update the TOC using the Word feature (right click and update). Do not break the headings. The headings are formatted to update the TOC using the edit table feature of Word.

List of Tables. x

List of Figures. xi

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

1.1 Introduction. 1

1.2 Capstone Topic. 1

1.2.1 Problem of Practice. 1

1.3 Purpose of the Project 1

1.3.1. Project Need. 1

1.3.2 Project Question(s) 1

1.3.3. Project Justification. 1

1.3.4 Project Context: Company or Industry. 1

1.3.5 Terms and Definitions. 1

1.4. Doctor of Business Project Specifications. 1

1.4.1. Importance of the Project 1

1.4.2. Approach for the Project 1

1.5 Summary. 1

SECTION 2. LITERATURE REVIEW AND PROJECT PLAN.. 2

2.1. Introduction. 2

2.1.1.  Applied Framework. 2

2.2. Method for Discovering Literature. 2

2.2.1. Inclusion and Exclusion Criteria. 2

2.2.2. Search Strategy. 2

2.3. Review of Scholarly and Practitioner Literature. 2

2.3.1. Historic and Current Business Problem Trends. 2

2.3.2.  Previous Efforts to Address the Problem.. 2

2.4. Summary of Literature. 2

2.5. Recruitment 2

2.6. Project Study Protocol 2

2.6.1 Data Sources. 2

2.6.2. Data Collection. 2

2.6.3. Data Analysis Plan and Presentation. 2

2.6.4 Validity and Reliability/Trustworthiness. 2

2.6.5 Ethical Considerations. 2

2.7. Overview of the Project Study Plan. 3

2.8 Summary and Conclusion. 3

SECTION 3. RESULTS, DISUSSION, AND IMPLICATIONS. 4

3.1 Introduction. 4

3.2. Data Collection Results. 4

3.3. Data Analysis. 4

3.4 Contribution to Theory, the Literature, and the Practitioner Knowledge Base. 4

3.5 Project Application and Recommendations. 5

3.6 Conclusion. 5

REFERENCES. 6

APPENDIX A. APPENDIX TITLE.. 7

PUBLISHING AGREEMENT. 8

STATEMENT OF ORIGINAL WORK.. 9

List of Tables

Table 1. Table Title [single-spaced and hanging if longer than one line], and add the page
number………………………………………………………………………………………………………. xx

Table 2.. Title ………………………………………………………………………………………………………….. xx

Note example Table 1 in Section 3. Leave one full blank line between entries.

List of Figures

Figure 1. Figure Title [single-spaced, hanging indent if longer than one line], and add the page
number………………………………………………………………………………………………………. xx

Figure 2. Title…………………………………………………………………………………………………………… xx

Leave one full blank line between entries. Note example Figure 1 in Section 3. Do not remove the section break that follows this paragraph.

SECTION 1. HEALTH ADMINISTRATION PROBLEM AND PROJECT SCOPE

1.1 Introduction

Aminata, you  need to introduce the topic in this area.  Most people will not know what “these practices” mean.  Perhaps: 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 (citations). The GI clinic that is the focus of this capstone was impacted by xxxxxxxx (what happened at the site)

GI clinics treat patients withTo adapt to the new normal, many of these practices had to reduce their clinic and endoscopic volumes to create capacity in other service areas. Diseases such as Ulcerative Colitis, Inflammatory Bowel Disease and Crohn’s Disease (citations), thatPatients with chronic illness were adequately and successfully managed prior to the pandemic (citation). However, once the clinic closure took place, a few, have seen patients reported experiencing new and uncontrolled symptoms due to the lack of diagnostic care and treatment during the pandemic.  To prevent overwhelming the healthcare system and prepare for a second or third wave of the pandemic in the future, GI operations will once again need to resume. Ami, you will need to report at where we are now in time and space. Note the brief history of the clinic during COVID and then move forward

Use active sentences. Avoid starting sentences with prepositions or verbs. Something like: The GI Clinic capstone site needed an implementation strategy to phase in re-opening and a triage system to ensure that patients with exacerbations or acute illnesses receive needed care. 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.  This could go in the Availab le knowled ge area

As the understanding the new[A1]  normal 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 thisand objectives of the capstone project will be:

1. Create a triaging process that categorizes urgent, semi-urgent and non-urgent patients cases 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[A2]  Society’s recommendations.

Reference:

Singh, A. & Day, L. (2020[A3] ). Life After Covid-19: Rescheduling Patients.

1.2 Capstone Topic

1.2.1 Problem of Practice

An endoscopy suite, like many other crucial medical processes, is a complex operation. Missed and cancelled appointments affect the healthcare industry directly, with a large impact on patient care.  Ami, write in full sentences and complete paragraphs. Include TAB indents to start each paragraph; add citations for sentences of fact.

I will let you work on rewriting these sections

With COVID-19 wasbeing declared a pandemic by the World Health Organization in March 2020 (citation). The pandemic caused, there was a proliferation of cancelled appointments for the GI clinic. The , a decision to cancel was made either by the patient or the physician’s office. The clinic canceled appointments These decisions were made to mitigate the risk of transmitting the virus to healthcare personnel or to chronically ill patientswithin the practice and to patients by deferring elective and preventative visits. All elective and preventive health visits were immediately cancelled (citation).  Consequently, pPractices were forced to close due to health care restrictions (citation). While Ttthe hese measures were implemented for the overall protection of the general population (citation). Closure of any type of clinic, it left a significant gap in care for patients who required ongoing care for chronic conditions or new, acute diagnoses.some of these life-saving procedures to improve their quality of life.

Continue in this theme of writing as I modeled above

The limitation to this approach is 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 have been 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.

Reference:

Telford, J., Rosenfeld, G., Thakkar, S., & Bansback, N. (2019). Patients’ Experiences and Priorities for Accessing Gastroenterology Care. Journal of the Canadian Association of Gastroenterology.

1.3 Purpose of the Project

1.3.1. Project Need

The purpose of this capstone project is to create a…

I stopped word tracking here…Adherence to the current guideline intervals has proven to improve patient outcomes, reduce the risk of harm and improves resource utilization.   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.

Reference:

Mohammadi I, Wu H, Turkcan A, Toscos T, Doebbeling BN. (2018). Data Analytics and Modeling for Appointment No-show in Community Health Centers. J Prim Care Community Health. 9:2150132718811692. doi:10.1177/2150132718811692

1.3.2 Project Question(s)

PQ1: For the American Gastroenterological Association, how do COVID-19 implementation practices affect a practice in San Francisco, CA in terms of rescheduling cancelled appointments and the accurate use of Personal Protective Equipment (PPE) for endoscopy procedures?  

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.

Reference:

Lieberman, DA, Faigel, DO, Logan, J, Mattek, N, Holub, J, Eisen, G, Morris, C, Smith, R, Nadel, M. Assessment of the Quality of Colonoscopy Reports: Results from a multi-center consortium. Gastrointest Endosc Vol 69, 2009 

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

 [Note to learners: the project’s sections 1 to 1.5 will be revised into past tense after you conduct the study and write Section 3. Delete these instructions.].

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:

 

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

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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) emphasize 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

Exclusion Criteria

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:

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:

2.7. Overview of the Project Study Plan

2.8 Summary and Conclusion

 [Note to learners: The project’s sections 1 to 2.13 will be revised into past tense after you conduct the study and write Section 3.].

SECTION 3. RESULTS, DISUSSION, AND IMPLICATIONS

3.1 Introduction

3.2. Data Collection Results

3.3. Data Analysis

Table 1. Example of a Capella APA Table

ItemsCounts
Item 1   Item 2   Item 3  4   6   21

Note. This general note describes some important items in this table. Delete this before using the template.

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

Figure 1. Example of a Capella APA Figure

Note. This figure, created by M. Bennett (2021), is open sourced and may be used by others, 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 7th edition, Rule 7.7 (p. 198) and all other pertinent rules for instructions on how to attribute unoriginal, copied figures. Delete this before using the template.

3.5 Project Application and Recommendations

3.6 Conclusion


REFERENCES

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Elli, L., Tontini, G. E., Scaramella, L., Cantù, P., Topa, M., Dell’Osso, B., & Penagini, R. (2020). Reopening endoscopy after the COVID-19 outbreak: Indications from a high incidence scenario. Journal of Gastrointestinal and Liver Diseases, 29(3), 295-299. http://dx.doi.org/10.15403/jgld-2687

Fatima, H., & Shin, A. (2020). Framework for safely reopening endoscopy during the COVID-19 pandemic: Redefining adequate preparation. Journal of Public Health Management and Practice26(6), 528-533. Doi: 10.1097/PHH.0000000000001235

Fiori, G., Trovato, C., Staiano, T., Magarotto, A., Stigliano, V., Masci, E., & Cannizzaro, R. (2020). Reorganization of the endoscopic activity of Cancer Institutes during phase II of the Covid-19 emergency. Digestive and Liver Disease52(11), 1346-1350. https://doi.org/10.1016/j.dld.2020.06.023

Francisco, C. P., Cua, I. H., Aguila, E. J., Cabral-Prodigalidad, P. A., Sy-Janairo, M. L., Dumagpi, J. E., … & Gopez-Cervantes, J. (2021). Moving forward: Gradual return of gastroenterology practice during the COVID-19 pandemic. Digestive Diseases39(2), 140-149. https://doi.org/10.1159/000511008

Furfaro, F., Vuitton, L., Fiorino, G., Koch, S., Allocca, M., Gilardi, D., & Peyrin-Biroulet, L. (2020). SFED recommendations for IBD endoscopy during COVID-19 pandemic: Italian and French experience. Nature Reviews Gastroenterology & Hepatology17(8), 507-516. https://doi.org/10.1038/s41575-020-0319-3

Gralnek, I. M., Hassan, C., Beilenhoff, U., Antonelli, G., Ebigbo, A., Pellisé, M., & Dinis-Ribeiro, M. (2020). ESGE and ESGENA position statement on gastrointestinal endoscopy and COVID-19: An update on guidance during the post-lockdown phase and selected results from a membership survey. Endoscopy52(10), 891. Doi: 10.1055/a-1213-5761

Grassia, R., Testa, S., De Silvestri, A., Drago, A., Cereatti, F., & Conti, C. B. (2020). Lights and shadows of SARS-CoV-2 infection risk assessment in endoscopy. Digestive and Liver Disease52(8), 816-818. Doi: 10.1016/j.dld.2020.06.013

Grossberg, L. B., Pellish, R. S., Cheifetz, A. S., & Feuerstein, J. D. (2020). Review of societal recommendations regarding management of patients with inflammatory bowel disease during the SARS-CoV-2 pandemic. Inflammatory Bowel Diseases.   https://doi.org/10.1093/ibd/izaa174

Guda, N. M., Emura, F., Reddy, D. N., Rey, J. F., Seo, D. W., Gyokeres, T., & Faigel, D. (2020). Recommendations for the operation of endoscopy centers in the setting of the COVID‐19 pandemic–World Endoscopy Organization guidance document. Digestive Endoscopy32(6), 844-850. https://doi.org/10.1111/den.13777

Hennessy, B., Vicari, J., Bernstein, B., Chapman, F., Khaykis, I., Littenberg, G., & Robbins, D. (2020). Guidance for resuming GI endoscopy and practice operations after the COVID-19 pandemic. Gastrointestinal Endoscopy92(3), 743-747. https://doi.org/10.1016/j.gie.2020.05.006

Kriem, J., & Rahhal, R. (2020). COVID-19 pandemic and challenges in pediatric gastroenterology practice. World Journal of Gastroenterology26(36), 5387. Doi: 10.3748/wjg.v26.i36.5387

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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.

CitationConceptual FrameworkDesign/ MethodSample/ SettingMajor Variables Studied and their DefinitionsMeasurementData AnalysisFindingsAppraisal: Worth to Practice
Elli et al. (2020)N/AN/AN/AN/AN/AN/AEffective management of personnel and patients reduces more health risks. These include space management, effective scheduling, and duration processes. Use interventions, such as video-capsule endoscopy. Strength: Gives effective recommendation on guidelines to re-opening endoscopy after COVID-19 pandemic. Weakness: N/A   Rank= High
Hennessy et al. (2020)N/AN/AN/AN/AN/AN/AThe top priority for patients and staffs include Screening procedures for patients before entering the EU and responses updated regularly.  Strengths: outlines different recommendations to protect clinical staff and the patients.   Weaknesses: Some proposed measures are challenging to implement in the healthcare setting. Rank= Average
Peery et al. (2020)N/AN/AN/AN/AN/AN/AGastroenterologists can protect themselves by limiting the number of people in patient rooms and making the EU more COVID-19 resistant.Strength: The article outlines effective strategies to encourage more patient visits while protecting healthcare personnel.   Rank= High
Guda et al. (2020)N/AN/AN/AN/AN/AN/AReopening of EU and protecting of the clinical staff is possible through using PPEs, managing patient flow, cleaning EU, and creating space.Strength: The outlined framework works effectively when adopted considerably by any EU towards limiting COVID-19 transmission and related risks.   Rank = High  
Machicado et al. (2020)N/AN/AN/AN/AN/AN/AEffective intraprocedural practices, such as appropriate use of PPEs reduces the chances of COVID-19 transmission.Strength: Addresses both effective and ineffective clinical interventions for EU. Rank = High
Das (2020)Changes on ambulatory endoscopic center (AEC) on throughput and other performance indicators A discrete event simulation-based model N/ANumber of endoscopy rooms Number of recover bays COVID-19 screening areas before endoscopy procedure Staffing variable, such as endoscopists, recovery RN, COVID-19 triage staffN/AN/APost COVID-19 recommendations changed the workflow in AEC significantly by decreasing staff and increasing time and an increase in facility wait time.  Strength: Simulated guidelines that are essential for endoscopists in clinical care after COVID-19 Weakness: Lack of clear guidelines for administration managers who bears the anticipated role for patient safety.   Rank = Average
Sharma & Dutta (2020)N/AN/AN/AN/AN/AN/ACOVID-19 has increased healthcare risks for gastroenterologists and protecting them is necessary through means such as routine testing of both patients and staff and use of UV radiation in the EU.Strength: Important insights on the effects of COVID-19 effects on gastroenterologists and useful strategies to protect clinical staff.   Rank = High
Niriella et al. (2020)N/AN/AN/AN/AN/AN/AGastroenterologists can protect themselves from the implications of COVID-19 by reducing contact with patients through means like telemedicine.Strength: The effective recommendation suggested protecting endoscopists and patients.   Rank = High
Kriem & Rahhal (2020)N/AN/AN/AN/AN/AN/AThere are challenges in administering care in the pediatric EU due to challenges in maintaining the safety of both care providers and patients. Useful strategies to protect both populations include making adjustments to the EU setting by creating more space, limiting the number of people in the EU room, and strict adherence to COVID-19 guidelines.  Strength: Recognizes challenges in pediatric EU and recommends protecting the pediatric healthcare workforce.   Rank = High
Grossberg et al. (2020)N/ASearch of the medical literature N/AN/AN/AN/AThe use of different recommendations from diverse healthcare organizations plays an important role in preventing COVID-19 transmission among IBD patients and providers.Strength: Outlines a list of references to the different recommendations provided by healthcare institutions for use in the EU.   Rank = High
Zhang et al. (2020)N/AN/AN/AN/AN/AN/AThe reopening of endoscopy centers depends on the epidemic curve and the number of confirmed cases locally, the accumulated cases of postponed cases, and the availability of medical equipment like PPEs.Strength: Recommendation from a tertiary medical center to help in GI control during the COVID-19 pandemic. Rank = High
Castagna et al. (2020)N/AData collection3079 patients (1417 upper endoscopies and 1662 colonoscopies)N/AN/AIn 6 EUs most cases were rescheduled by 27.5% – 85% of patients and cancellation by 10% – 57.5% of patients.    Procedures were adjusted based on the case priority based on the severity of the patient’s condition.    Weakness: Highlights recommendations without outlining implementation processes. Rank = Low
Furfaro et al. (2020).  N/AN/AN/AN/AN/AN/AProtecting patients with IBD is necessary before, during, and after procedures. However, gastroenterologists need to protect themselves from COVID-19 while attending to patients through applying telehealth procedures. Weakness: Focuses mainly on the IBD cases during the COVID-19 pandemic with no future recommendation.   Rank= Low 
Ménard et al. (2020).N/AN/AN/AN/AN/AN/AA flexible, stepwise, and adaptive approach is needed to prevent COVID-19 transmission within the EU. Emphasis must be placed on the priority of care.Strength: Outlines the scenarios that limit the protection of gastroenterologists as means to identify gas during EU procedures. Rank = High
Fatima & Shin (2020).N/AN/AN/AN/AN/AN/AReopening the endoscopy units necessitate prioritizing cases, preparing gastroenterologists, and monitoring patients before, during, and after aftercare.Strength: Comprehensive strategies to reopening EU.   Rank = High
Gralnek et al. (2020).N/ALiterature search and SurveyA survey administered to all ESGE individual membersN/AN/AN/APatient fears when visiting the EU should be properly addressed through enhancing GI endoscopy procedures through training and research activities.Strength: Recommends useful strategies during the reopening of EU after COVID-19. Rank = High
Bleier et al. (2021)N/AN/AN/AN/AN/AN/AProviders to remains aware of local, state, and federal guidelines concerning infection control. Pre-visit screening should be conducted. Adherence to CDC guidelines.Strength: Outlines effective ways towards reopening EU during COVID-19, which is effective to post COVID-19.   Rank= High
Zhao et al. (2020)N/AN/AN/AN/AN/AN/AEmphasis on patient screening and triage, endoscopy staff protection, and effective EU equipment handling.Strength: Recognizes essential areas towards safer re-opening of EU after the pandemic.   Rank = high
Yu et al. (2021)N/AN/AN/AN/AN/AN/AFormulation of intervention protocol is key towards protecting both patients and staff. Key indicators include hospital disinfection and separation, disinfection of procedure rooms, personnel training, and waiting are management.Strength: Step by step procedure on the effective recommendation that is essential during and after COVID-19 reopening of EUs.
Fiori et al. (2020)N/AN/AN/AN/AN/AN/AEssential processes to limit COVID-19 transmission when EU reopen include infection containment measures like triage, selecting cases based on priority and appropriateness and rescheduling deferred procedures.Strength: Comprehensive coverage of means to reopen EU post-COVID-19.   Rank = High


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 [A1]don’t call this situation the “new normal”. It is not.

 [A2]this will need some sort of background, too

 [A3]the references should go at the end of the document