Los Angeles County Department of Health Services (LAC-DHS) is a huge organization comprised of multiple large complex facilities with their own unique culture, leadership, policies, and procedures. It can be extremely difficult to implement a system-wide operational approach within the organization due to this landscape, especially in a time limited capacity. Early in the pandemic, LAC-DHS shut down all outpatient GI procedures for six months. This created a huge GI procedure backlog and delay in diagnostic care. Due to COVID-19 budget restrictions, there were no new available resources to solve the problem. Therefore, we needed a multi-pronged innovative strategy to address the backlog and deliver much needed diagnostic and therapeutic services to our patients. Before starting this project, the GI services at LAC-DHS had no standardized electronic data tracking system, no GI specific nursing protocols, and no standard procedure delivery workflows across the system. Our goal was to decrease the GI procedure backlog from 6,000 procedures to 1,500 procedures from August 2020 to March 2021. We accomplished this goal by developing and implementing an electronic procedure queue with triage capabilities, multiple nursing/pharmacy standardized protocols, cross-facility scheduling throughput, and standard policies and procedures across LAC-DHS GI departments.