David Hudesman, MD, on How I Practice Now: Nonurgent vs Urgent IBD Patient Visits

In this video, Gastroenterology Consultant Advisory Board Member David Hudesman, MD, talks about overcoming the challenges associated with the COVID-19 pandemic, how he has been defining urgent and nonurgent patient procedures, and the tips he has been giving his patients with inflammatory bowel disease. 

Additional Resources:

 COVID-19 Care360.

David Hudesman, MD, is codirector of the Inflammatory Bowel Disease Center at NYU Langone Health and is an associate professor of medicine at the NYU School of Medicine in New York City.

TRANSCRIPT:

David Hudesman: Hello, my name is Dr. David Hudesman. I’m the codirector of the Inflammatory Bowel Disease Center at NYU Langone Health in New York City. I’m going to speak a little bit about my and our center’s experience dealing with the COVID-19 pandemic at our IBD center and at our institution.

Unfortunately, New York City is that the epicenter for this. This is something that we've been dealing with for well over a month now, and I'm sure it's everyone else's is something that's very fluid, which is constantly changing day to day, hour to hour.

I think the key messaging … I think we've been sending out blast messages to our patients, both to remind them about what's happening, what's going on, general recommendations, such as washing hands meticulously social distancing, and so forth, as well as some recommendations about their medications but also letting them know that if needed, our center is fully functional.

Now it's not fully functional how it was a few months ago. What I mean by that is if needed we’re able to see patients in the office. If needed, we’re able to endoscopies, colonoscopies, sigmoidoscopies, and so forth, and we’re able to continue our infusion practices.

However, where we've shifted is, that key term is “if needed,” and really anything that's nonurgent. We've been trying to keep [patients] out of the office out of the health care system to minimize that risk of developing COVID.

As you can imagine, there's a lot of anxiety in the general population for everyone about this, but also in many of our patients are on some type of immunosuppressive biologic or small molecule therapy.

So, first when talking about our visits, almost all of our visits now are virtual or telehealth. This is including follow-up patients, semiurgent cases, as well as new patients who have never been in the office to see us. Mostly we're doing Telehealth. Again, if needed, in a very urgent situation, and certain clinical trial patients, we are still having them come into the office, but that's very few and far between.

Procedures … we've significantly limited what types of procedures we're doing. Again, we're not doing any nonurgent procedures. The way we have been defining that is if the colonoscopy or endoscopy—or whatever procedure may be—will not change management within the next couple of months, then we are not doing that procedure. However, the recent cases we have done is somebody with severe ulcerative colitis, and it was unclear what was driving that and we wanted to take a look inside to help better guide next steps and management.

So those cases are still being done, as well as somebody with high-grade dysplasia that needed an EMR or endoscopy mucosal resection. So again, I'm still able to do cases but really only limiting things that are urgent that's going to change how I'm going to manage that patient.

Infusion services … we're still fully functioning. We're still infusing our patients. I think 3 key messages we're telling our patients are:

1. Active inflammation is one of our big concerns with this disease, with this virus (COVID-19). Staying on your medications are key, whether these are immunosuppressive biologics are small molecules.
2. Prednisone is not a good thing. We draw a lot of that data from the first SARS virus. Some patients may still need prednisone or maybe are on prednisone, but really actively trying to taper them off is key.
3. The third thing, which sort of ties into the first 2, is staying on your medication. Because of that, our infusion center remains open. And I'm encouraging my patients to come to our infusion center, rather than shifting to somewhere else, shifting to home infusion—not because these other centers or home infusions are not reasonable options. It's just there's factors that I can't control. What we can control in our fusion centers—how we're cycling nurses, how we're spacing out our patients, how patients … when they're coming into the office, they’re screened before they even reach the elevator and again up here, and everything's clean. I can control that, whereas these other factors, such as home infusions or other sectors, I don't know exactly what's happening. So, we're keeping them on their infusions.

Thank you very much.