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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