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Ambulatory Endoscopy in Ontario- Current Practice Patterns
Transcript of Ambulatory Endoscopy in Ontario- Current Practice Patterns
D O U G H E M P H I L L M D , F R C P ( C )
B A R R I E E N D O S C O P Y
T H E R O Y A L V I C T O R I A H O S P I T A L , B A R R I E , O N
Ambulatory Endoscopy in Ontario-Current Practice Patterns
Ambulatory Clinics in Ontario
Little known about out of hospital endoscopy activity in Ontario
No requirement to declare site of endoscopic activity with CPSO, OMA, or specialty organizations
No accreditation process or organization
Ministry could be aware (Tray fee E749 or group billing numbers)
Estimate of proportion of Ontario colonoscopies done in out of hospital settings is 20% (Linda Rabeneck- personal communication)
Ambulatory Endoscopy in Ontario- Finding the Clinics
Diverse group- Surgeons/Gastros/Other, endoscopists who have and those that don’t have hospital privileges.
Sources of information
Industry
Registration
Word of mouth
We don’t have a complete list
Endoscopy Clinics in Ontario
1. Albany Clinic
2. Barrie Endoscopy
3. Bluewater Surgical Centre
4. Bray
5. Brunswick Clinic
6. Byrne
7. Digestive Health
8. Desai
9. Downsview Endoscopy
10. Durham Endoscopy Centre
11. Elkashab
12. Endoscopy Clinic of Greater Toronto
13. Farmed Endoscopy
14. Gastroenterology Group
15. GTA Endoscopy
16. Holly Street Endoscopy
17. Intestinal Health
18. Kensington Endoscopy
19. Maple Endoscopy
20. Missisauga Colonoscopy
21. North Scarborough Endoscopy
22. North Toronto GI Clinic
23. North York Endoscopy
24. Markham Endoscopy
25. Oakville Endoscopy Centre
26. Oshawa Clinic Endoscopy
27. Ottawa Endoscopy
28. Patel
29. Polyclinic
30. PES-Rudd Clinics
31. SCOPE Clinic
32. Surrey Clinic
33. Toronto Clinic
34. The Toronto GI Clinic
35. Upper Canada Lower Bowel
36. Vaughan Endoscopy
37. West GTA Endoscopy
Endoscopy Clinics in Ontario
1. Albany Clinic
2. Barrie Endoscopy
3. Bluewater Surgical Centre
4. Bray
5. Brunswick Clinic
6. Byrne
7. Digestive Health
8. Desai
9. Downsview Endoscopy
10. Durham Endoscopy Centre
11. Elkashab
12. Endoscopy Clinic of Greater Toronto
13. Farmed Endoscopy
14. Gastroenterology Group
15. GTA Endoscopy
16. Holly Street Endoscopy
17. Intestinal Health
18. Kensington Endoscopy
19. Maple Endoscopy
20. Missisauga Colonoscopy
21. North Scarborough Endoscopy
22. North Toronto GI Clinic
23. North York Endoscopy
24. Markham Endoscopy
25. Oakville Endoscopy Centre
26. Oshawa Clinic Endoscopy
27. Ottawa Endoscopy
28. Patel
29. Polyclinic
30. PES-Rudd Clinics
31. SCOPE Clinic
32. Surrey Clinic
33. Toronto Clinic
34. The Toronto GI Clinic
35. Upper Canada Lower Bowel
36. Vaughan Endoscopy
37. West GTA Endoscopy
1. How many years has your clinic been in operation? (22 responses)
Average 6.86 yrs
Range 3 months to 40 years
11 Clinics 3 yrs or less # of clinics
>1oyrs
4-10 yrs
3yrs or less
2. How many doctors perform endoscopies at your clinic on a regular basis? (22 responses)
General Surgeons 2.9/clinic 58 Total
Gastroenterologists 3.43/clinic 72 Total
Other 1
Number of Clinics GI only 5
Number of Clinics General Surgery Only 1
3. What proportion (%) of doctors working regularly at your clinic have active hospital privileges?
100% hospital privileges 10 clinics
0% hospital privileges 6 clinics
20%-90% hospital privileges 6 clinics
4. How many procedures are done in your clinic per year? (21 clinics responded)
Total Average/Clinic
Range Median/Clinic
Colonoscopies 65,528 3,120 156-22,250 2500
Gastroscopies 13,915 662 0-3,650 400
Sigmoidoscopies 7,948 418 0-6,050 50
5. Can patients be referred for gastroscopy only (not associated with a colonoscopy)?
0 20 40 60 80
No
Yes
Response %
6. How many procedure rooms at your clinic are used for endoscopy most days?
# procedure rooms
1
2
>2
15 of 19 clinics have unused procedure rooms for future
expansion
7. How are your patients referred?
0 10 20 30 40 50 60
Combination of All or Other
Referred to Endoscopists Offices (Procedure at the Clinic)
Clinic and Office Same Location
Direct to Clinic
Response Frequency
8. Do patients have their procedure performed on the same day as the consultation?
0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00%
Yes
No
Response Rate
9. Indications for referral for endoscopy at your clinic.
0 20 40 60 80 100 120
Reflux
Dyspepsia
Melena
Altered Bowel Habit
Abdominal Pain
Anemia
Rectal bleeding
FOBT
Screening/Surveillence
Response %
10. What types of co morbidity exclude patients from having procedures at your clinic?
0 20 40 60 80 100
ASA IVASAIII
Prev CVA/TIARenal Impairment- Dialysis
Renal Impairment-Mild/ModerateAnticoagulation (Coumadin)
Obesity (BMI>40)Sleep Apnea
Diabetes- InsulinDiabetes-Oral Agents or Diet
COPD/Ashma- moderate/severeCOPD/Asthma-mild, controlled
CHF (stable)Recent MI/ACS
Remote MI/ACS
Response %
11. What therapeutic procedures do you perform at your clinic?
0 20 40 60 80 100 120
Hemmorhoid banding/injection/other
Tatooing
Variceal Ligation
Bicap/Heater probe/APC
Dilation
Clips
Injection Therapy
Polyp Fulgarization (hot bx)
Snare Polypectomy
Biopsy
Response %
12. Which colonoscopy prep do you most commonly use?
0 10 20 30 40 50
Pico Salax (2 sachets) + Dulcolax
Pico Salax ( 2 sachets)
Pico Salax (3 sachets)
Pico Salax + MgCitrate
PEG + phosphosoda
Phosphosoda
PEG
MgCitrate
Response %
13. What sedation agents are used at your clinic?
0 20 40 60 80 100
Droperidol
Ketamine
Versed
Demerol
Fentanyl
Valium (Diazemuls)
Propafol without Anaesthiologist
Propafol with Anaesthiologist
Response%
14. What patient monitoring is performed?
0 20 40 60 80 100 120
Capnography (C02 monitering)
Continuous ECG
Manual BP
Automatic BP
Oxymetry (02 sat)
Series 1
17. What indicators of quality care do you regularly monitor and record?
0 20 40 60 80 100
Withdrawal Time
Surveillence Interval
Prep Quality
Adenoma Detection Rate
Polyp Detection Rate
Cecal Intubation-photo
Cecal Intubation-documentation
Complications
Response%
19. Is your clinic involved in marketing or advertising?
0 20 40 60 80 100
To referring physicians
To the public
Response %