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

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

0 10 20 30 40 50 60 70

Other

RPNs

RNs

Response Rate

16. Scope Reprocessing.

0 20 40 60 80 100

Automatic Washers

Manual

Response %

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%

18. Are you an accredited with any organization?

0 20 40 60 80 100

No

Yes

Response %

19. Is your clinic involved in marketing or advertising?

0 20 40 60 80 100

To referring physicians

To the public

Response %

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

0 10 20 30 40 50 60 70

No

Yes

Response %

END