Triage of colonoscopies: open access endoscopy versus consultation carried out by a gastroenterologist.

Wichers, C.D. (2013) Triage of colonoscopies: open access endoscopy versus consultation carried out by a gastroenterologist. thesis, Medicine.

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Abstract

Background: Open access endoscopy (OAE) implies that physicians can refer their patient for colonoscopy without prior consultation by a gastroenterologist. Despite the benefits of OAE, concern has been raised about the increasing number of unnecessary colonoscopies. We prospectively studied the effect of consultation carried out by a gastroenterologist prior to the requested colonoscopy, compared with OAE on the number of declined colonoscopies and the assessment of urgency. Secondly, we aimed to evaluate the extent to which prior consultation contributes to complete medication and past medical history of the referral, compared with the OAE application. Methods: Referrals of 255 consecutive patients for colonoscopy were criticized using both an evaluation form for OAE and a consultation of 7,5 minutes carried out by a gastroenterologist. Statistical analyses were performed using the McNemar Test and the Wilcoxon signed rank test. Results: Declination of direct scheduling of the colonoscopy occurred in 6.3% and 11.4 % of the patients based on OAE and on prior consultation, respectively [P=0.02]. Main reasons for declination of colonoscopy by consultation included diagnosis of IBS (20.7%), recent performed colonoscopy (10.3%) and incorrect surveillance (17.2%). Seven of the 16 referrals (43.8%) declined by OAE were approved during the consultation. Main reasons (71.4%) for approval were missing indications and information on the application form. Based on OAE and consultation 43.9% and 25.5% of the colonoscopies were marked as urgent, respectively. In 13 of the 224 (5.8%) performed colonoscopies a malignancy was found. In addition, this was the case in 6.3% and 10.8% of the colonoscopies marked as urgent by OAE and consultation, respectively. Both, OAE and prior consultation, showed an association between urgency and malignancy [P<0.001]. In 31.5% of the referrals, medication noted on the application form was incomplete. However, specified for most relevant groups of medication (insulin and relevant anticoagulants), this was only in 1.6% of the cases. In addition, relevant medical history was not mentioned in 54.9% of the application forms (abdominal surgery 35.8%, cardiac disease 15.4%, COPD 3.1%, prior malignancy 3.7%, diabetes mellitus 3.0% and coagulation disorder 0.6%). Conclusion: Prior consultation by gastroenterologists is preferable, since it more precisely assesses whether colonoscopy is indicated and consequently could drastically lower the annual amount of unnecessary colonoscopies. In addition, prior consultation gives complete information about past medical history and current medication and it estimates the degree of urgency more precisely. Declination of colonoscopies by reviewing the application forms alone seems not to be safe. Our findings suggest that consultation prior to colonoscopy is a tool to improve the quality and safety of medical care.

Item Type:	Thesis (Thesis)
Supervisor name:	Herwaarden, MA van MD PhD and Deventer Hospital
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:41
Last Modified:	25 Jun 2020 10:41
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/294

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