fiber optic exams for H&N patients during COVID-19?

[FreakFlag]

For H&N patients who would benefit from a radonc fiberoptic exam (consult or f/u) during the current COVID-19 wave, are you sending them for PCR testing a few days beforehand and advising pre-procedure quarantine?

Or just skipping the radonc fiberoptic and instead relying on ENT's report and digital photos?

Thanks

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[RadOncDoc21]

For H&N patients who would benefit from a radonc fiberoptic exam (consult or f/u) during the current COVID-19 wave, are you sending them for PCR testing a few days beforehand and advising pre-procedure quarantine?

Or just skipping the radonc fiberoptic and instead relying on ENT's report and digital photos?

Thanks

I’ve been skipping.

 

[medgator]

I’ve been skipping.

The ent is covid testing before each scope, they are more set up for the extra logistics of it than we are, agree

 

[drewdog1973]

I don’t trust the general ENTs to stage them properly. Some of the head and neck guys do a fairly good job.

We Covid test before every sim, so that’s when I scope them. If the scope would change the treatment plan, would scope the day before sim (we would use the same results of the Covid test- wouldn’t re check).

 

[thecarbonionangle]

PCR when possible. N95 mask always. Never skip scope

 

[evilbooyaa]

I don't bother with pCR the (albeit rare) times I scope. Just treat it like a positive patient - N95, gown, etc.

That being said, if referring ENT (who have better scopes than I do anyways) can get them in within a few days I send them over. ENTs have up-to-date scopes that can take pictures with their set-ups and include in their note as part of the EMR.

 

[drewdog1973]

Umm... I can take pictures with my set-up and include in my note. It isn't a skill taught in surgery residency

 

[evilbooyaa]

Umm... I can take pictures with my set-up and include in my note. It isn't a skill taught in surgery residency

I could do that as well during residency. My scopes in my current practice, we'll just say, leave quite a bit to be desired. Not a skills issue, just a technology/equipment issue.

 

[drewdog1973]

I don't bother with pCR the (albeit rare) times I scope. Just treat it like a positive patient - N95, gown, etc.

That being said, if referring ENT (who have better scopes than I do anyways) can get them in within a few days I send them over. ENTs have up-to-date scopes that can take pictures with their set-ups and include in their note as part of the EMR.

From workflow perspective, you say you treat them as if positive...

Does that mean your clinic will take a consult on a positive patient and start them on time ? Because if we had a patient test positive (before starting), things would change. I wonder about our workflow - we do the testing - but what are we really supposed to do with a positive patient? Wait? Start?

I find it confusing that we are demanding every patient get a test but at the same time don't test staff/docs frequently.

A lot of this is theater.

 

[evilbooyaa]

From workflow perspective, you say you treat them as if positive...

Does that mean your clinic will take a consult on a positive patient and start them on time ? Because if we had a patient test positive (before starting), things would change. I wonder about our workflow - we do the testing - but what are we really supposed to do with a positive patient? Wait? Start?

I find it confusing that we are demanding every patient get a test but at the same time don't test staff/docs frequently.

A lot of this is theater.

Treat them during a high-risk procedure (like a scope), as if they were positive. Meaning N95 100% of the time.

If a patient was confirmed positive, no we would not schedule them for in person consultation.

A lot of this is theater. I'm not the one making the policies.

Folks are instructed to wear masks at all times while they are in clinic.

 

[drewdog1973]

I'm not saying you - meaning your facility (and mine) - you're not treating them as if they were positive. You are treating them as if they were negative, because you allowed them to come in. If they were positive, you would not schedule them for in person consultation.

 

[medgator]

PCR when possible. N95 mask always. Never skip scope

You procto'ing and EGD'ing your goose/rectal cancers before contouring also? It's nice to scope, but sometimes isn't always feasible in a multi-location practice (have to worry about transporting it, cleaning/disinfecting it, covid test coordination etc.), Plus as others have alluded to, some of us have the older scopes with eye pieces or video monitors that don't print out pics for the EMR etc.

 

[evilbooyaa]

I'm not saying you - meaning your facility (and mine) - you're not treating them as if they were positive. You are treating them as if they were negative, because you allowed them to come in. If they were positive, you would not schedule them for in person consultation.

We still treat them 'as potentially positive' despite the COVID screening )temp check and series of questions) done by front staff. If we go by your definition and treated each patient as if they were negative for COVID, we wouldn't have any masking requirements for them. That's been the backbone of all this from the beginning - assume everyone you meet is positive. Hence masks.

At end of the day, the only time a patient testing positive (at some point) affect me is if I am not wearing appopriate PPE (N95, mask, etc.) during an exam that has high risk of aerosolization.

Had a consult (in-person) who called two days after to let me know he has tested positive. Since we both wore masks the whole time, didn't shake hands, did regular hand hygiene, etc, I thanked him for letting me know and went about the rest of my day. No isolation, no quarantine, no testing for me, etc.

If I had a scope patient, where I didn't wear N95, and same situation happened, now I would have to likely isolate/quarantine/test per institutional standards.

 

[seper]

I stopped scopes in October.. N95 is not a 100% tight fit (would have failed fit test). We have to re-use and clean them. Googles are poor fit and get foggy all the time.

 

[drewdog1973]

"potentially positive" is different than

We still treat them 'as potentially positive' despite the COVID screening )temp check and series of questions) done by front staff. If we go by your definition and treated each patient as if they were negative for COVID, we wouldn't have any masking requirements for them. That's been the backbone of all this from the beginning - assume everyone you meet is positive. Hence masks.

At end of the day, the only time a patient testing positive (at some point) affect me is if I am not wearing appopriate PPE (N95, mask, etc.) during an exam that has high risk of aerosolization.

Had a consult (in-person) who called two days after to let me know he has tested positive. Since we both wore masks the whole time, didn't shake hands, did regular hand hygiene, etc, I thanked him for letting me know and went about the rest of my day. No isolation, no quarantine, no testing for me, etc.

If I had a scope patient, where I didn't wear N95, and same situation happened, now I would have to likely isolate/quarantine/test per institutional standards.

I’m not getting tricked into getting KHE’d...

 

[thecarbonionangle]

You procto'ing and EGD'ing your goose/rectal cancers before contouring also? It's nice to scope, but sometimes isn't always feasible in a multi-location practice (have to worry about transporting it, cleaning/disinfecting it, covid test coordination etc.), Plus as others have alluded to, some of us have the older scopes with eye pieces or video monitors that don't print out pics for the EMR etc.

Sounds like you need a better scope.

 

[RadOncDoc21]

I got the biggest and best scope, everybody says so.

However, these days I’m all about cutting risk down of infection. I let the ENT docs do their thing while I can give radiation from a distance.

 

[kimplera]

When possible we have pts PCR test prior to visit, but logistically this is challenging - in reality - if scope is needed - gloves, N95, face shield, no aerosolized lidocaine (i currently mix with the surgilube and coat the scope) and proceed.
We do not scope for oral cavity or tonsil unless clinical indication, imaging suggests additional disease, or we have concerns about the extent of primary on physical exam.
Frankly - i think the risk of aerosolization for a mirror exam and palpation of BOT/valeculla is probably as great as with a scope, but don't tell ID that...

 

[Neuronix]

I have an N99 mask with N100 particulate filters and a face shield. I'm not going in anyone's airway with anything less.

N95 masks do not fit my face, and I would strongly encourage fit testing before any airway exams.

 

[temujim]

For H&N patients who would benefit from a radonc fiberoptic exam (consult or f/u) during the current COVID-19 wave, are you sending them for PCR testing a few days beforehand and advising pre-procedure quarantine?

Or just skipping the radonc fiberoptic and instead relying on ENT's report and digital photos?

Thanks

We temp and question screen everyone who walks through the door. Screen negative patients who have been tested have a positivity rate of less than 0.2% where I practice. I do the scope just like I did before covid. YMMV based on local factors.

 

[seper]

18% positive rate this week at our center

We temp and question screen everyone who walks through the door. Screen negative patients who have been tested have a positivity rate of less than 0.2% where I practice. I do the scope just like I did before covid. YMMV based on local factors.