DOUG HEMPHILL MD, FRCP(C)BARRIE ENDOSCOPY

THE ROYAL VICTORIA HOSPITAL, BARRIE, ON

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 organizationMinistry 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 Clinic2. Barrie Endoscopy3. Bluewater Surgical Centre4. Bray5. Brunswick Clinic6. Byrne7. Digestive Health8. Desai9. Downsview Endoscopy10. Durham Endoscopy Centre11. Elkashab12. Endoscopy Clinic of Greater Toronto13. Farmed Endoscopy14. Gastroenterology Group15. GTA Endoscopy16. Holly Street Endoscopy17. Intestinal Health18. Kensington Endoscopy19. Maple Endoscopy

20. Missisauga Colonoscopy21. North Scarborough Endoscopy22. North Toronto GI Clinic23. North York Endoscopy24. Markham Endoscopy25. Oakville Endoscopy Centre26. Oshawa Clinic Endoscopy27. Ottawa Endoscopy28. Patel29. Polyclinic30. PES-Rudd Clinics31. SCOPE Clinic32. Surrey Clinic33. Toronto Clinic34. The Toronto GI Clinic35. Upper Canada Lower Bowel36. Vaughan Endoscopy37. West GTA Endoscopy

Endoscopy Clinics in Ontario

1. Albany Clinic2. Barrie Endoscopy3. Bluewater Surgical Centre4. Bray5. Brunswick Clinic6. Byrne7. Digestive Health8. Desai9. Downsview Endoscopy10. Durham Endoscopy Centre11. Elkashab12. Endoscopy Clinic of Greater Toronto13. Farmed Endoscopy14. Gastroenterology Group15. GTA Endoscopy16. Holly Street Endoscopy17. Intestinal Health18. Kensington Endoscopy19. Maple Endoscopy

20. Missisauga Colonoscopy21. North Scarborough Endoscopy22. North Toronto GI Clinic23. North York Endoscopy24. Markham Endoscopy25. Oakville Endoscopy Centre26. Oshawa Clinic Endoscopy27. Ottawa Endoscopy28. Patel29. Polyclinic30. PES-Rudd Clinics31. SCOPE Clinic32. Surrey Clinic33. Toronto Clinic34. The Toronto GI Clinic35. Upper Canada Lower Bowel36. Vaughan Endoscopy37. West GTA Endoscopy

1. How many years has your clinic been in operation? (22 responses)

Average 6.86 yrsRange 3 months to 40 years11 Clinics 3 yrs or less # of clinics

>1oyrs

4-10 yrs

2. How many doctors perform endoscopies at your clinic on a regular basis? (22 responses)

General Surgeons 2.9/clinic 58 TotalGastroenterologists 3.43/clinic72 TotalOther 1

Number of Clinics GI only 5Number of Clinics General Surgery Only

1

3. What proportion (%) of doctors working regularly at your clinic have active hospital privileges?

100% hospital privileges 10 clinics0% hospital privileges 6 clinics20%-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)?

No

Yes

0 10 20 30 40 50 60 70 80

Response %

6. How many procedure rooms at your clinic are used for endoscopy most days?

# procedure rooms

12>2

15 of 19 clinics have unused procedure rooms for future

expansion

7. How are your patients referred?

Combination of All or Other

Referred to Endoscopists Offices (Procedure at the Clinic)

Clinic and Office Same Location

Direct to Clinic

0 10 20 30 40 50 60

Response Frequency

8. Do patients have their procedure performed on the same day as the consultation?

Yes

No

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00%

Response Rate

9. Indications for referral for endoscopy at your clinic.

Reflux

Melena

Abdominal Pain

Rectal bleeding

Screening/Surveillence

0 20 40 60 80 100 120

Response %

10. What types of co morbidity exclude patients from having procedures at your clinic?

ASA IV

Prev CVA/TIA

Renal Impairment-Mild/Moderate

Obesity (BMI>40)

Diabetes- Insulin

COPD/Ashma- moderate/severe

CHF (stable)

Remote MI/ACS

0 10 20 30 40 50 60 70 80 90

Response %

11. What therapeutic procedures do you perform at your clinic?

Hemmorhoid banding/injection/other

Tatooing

Variceal Ligation

Bicap/Heater probe/APC

Dilation

Clips

Injection Therapy

Polyp Fulgarization (hot bx)

Snare Polypectomy

Biopsy

0 20 40 60 80 100 120

Response %

12. Which colonoscopy prep do you most commonly use?

Pico Salax (2 sachets) + Dulcolax

Pico Salax ( 2 sachets)

Pico Salax (3 sachets)

Pico Salax + MgCitrate

PEG + phosphosoda

Phosphosoda

PEG

MgCitrate

0 5 10 15 20 25 30 35 40 45 50

Response %

13. What sedation agents are used at your clinic?

Droperidol

Ketamine

Versed

Demerol

Fentanyl

Valium (Diazemuls)

Propafol without Anaesthiologist

Propafol with Anaesthiologist

0 10 20 30 40 50 60 70 80 90

Response%

14. What patient monitoring is performed?

Capnography (C02 monitering)

Continuous ECG

Manual BP

Automatic BP

Oxymetry (02 sat)

0 20 40 60 80 100 120

Series 1

15. Nurses- what proportion are RNs vs. RPNs?

Other

RPNs

RNs

0 10 20 30 40 50 60 70

Response Rate

16. Scope Reprocessing.

Automatic Washers

Manual

0 10 20 30 40 50 60 70 80 90 100

Response %

17. What indicators of quality care do you regularly monitor and record?

Withdrawal Time

Prep Quality

Polyp Detection Rate

Cecal Intubation-documentation

0 10 20 30 40 50 60 70 80 90 100

Response%

18. Are you an accredited with any organization?

No

Yes

0 10 20 30 40 50 60 70 80 90 100

Response %

19. Is your clinic involved in marketing or advertising?

To referring physicians

To the public

0 10 20 30 40 50 60 70 80 90 100

Response %

20. Does your clinic charge patients a non-OHIP fee?

No

Yes

0 10 20 30 40 50 60 70

Response %

END