Table 1.

Prioritization Framework for Shared Decision Making

	Medical urgency (ongoing assessment of risk of disease progression based on debilitation, disability, pain, and other key clinical symptoms and factors)
	Low	High
COVID-19 and procedure-related risk (risk scores developed based on predictive analytic tools based on 2168 COVID-19–positive patients and 170,814 surgical patients)
Low	Consider nonprocedural care if available and discuss potential for long waiting time due to COVID-19–related deferred procedures	Priority to invite to proceed with procedures/surgery
High	Shared decision making to consider nonprocedure care. For patients ≥75 years of age for whom surgery is a consideration, use the American College of Surgeons geriatric surgery verification program)	Ongoing encouragement to optimize preprocedure health (based on risk factors known to improve outcomes) while awaiting procedure date
Medical urgency: gastroenterology Case Examples
Schedule now	Schedule first after “schedule now” completed	Schedule after other categories addressed (likely >3 months)
•FIT positive (especially ≥3 months since positive test result) •Esophageal dysphagia (not globus) •IBD flare •Progressive or acute iron deficiency anemia (within 6 months) •GERD/abdominal pain/dyspepsia in older patients (≥60 years) with warning symptoms) •Unexplained weight loss with negative imaging findings •Rectal bleeding in the absence of prior imaging •GI workup before priority transplant/surgical referral •Melena •Imaging suggestive of cancer •Obstructive jaundice	•Chronic iron deficiency (eg, premenopausal female patient) •FIT positive (<3 months since positive test result) •GERD/abdominal pain/dyspepsia in younger patients (<60 years) with warning symptoms (tele-consult also) •Follow-up colonoscopy after high-risk polyp resection (eg, carcinoma in situ, high-grade dysplasia, possible incomplete resection) •Barrett’s esophagus with high-risk features (nodules, high-grade dysplasia) or for ablation •Variceal banding for secondary prophylaxis •Follow-up gastric ulcers to exclude cancer	•GERD/abdominal pain/dyspepsia in younger patients (<60 years) without warning symptoms •Varices screening •Routine Barrett’s esophagus surveillance •Bravo/pH probes •Routine screening colonoscopy •Colonoscopy for family history of colorectal cancer • Surveillance in low-risk patients o History of low-risk polyp (lacks features of column 2) o IBD surveillance

NOTE. Prioritization framework for shared decision making based on 3 primary axes: (1) medical urgency of surgical procedure based on potential for clinical deterioration, (2) COVID-19 and surgical risk based on quantitative tools, and (3) PPE availability. The availability of PPE is a key overarching consideration for effective and sustainable procedure/surgical reopening. Additional factors for consideration include anesthetic approach, home vs inpatient recovery, local COVID-19 case activity, public health agency guidance and regulations, and regional aggregate procedure-related care availability.

GERD, gastroesophageal reflux disease; GI, gastrointestinal; IBD, inflammatory bowel disease.