562 Triage Surveys Are a Safe and Efficient Method to Streamline Utilization of Direct Access Endoscopy

Abstract

INTRODUCTION: Direct Access Endoscopy (DAE) is a process by which Gastroenterology (GI) practices provide patients with access to endoscopic intervention without incurring delays in awaiting GI clinic visits. Medstar Georgetown University Hospital (MGUH) employs the DAE mechanism through a triage system called Discussed with Patient (DWP) survey which is a screening questionnaire administered by central scheduling to determine which patients are low enough risk to safely bypass a pre-procedural clinic visit. This study was designed to evaluate safety and efficacy of our DWP triage system. METHODS: We performed a retrospective chart review of outpatient endoscopic procedures using our department's procedure scheduling system and electronic medical record system. Inclusion criteria included colonoscopy and EGD procedures performed by MGUH GI attendings from October 1-31, 2018 (total 23 working days). To focus data analysis, other procedures (i.e.; ERCP, EUS, MRCP, Flex sig) were excluded. We then analyzed patient demographics, indication for procedure, and safety documentation recorded within triage surveys. RESULTS: 727 total endoscopic procedures were analyzed. Sixty-five percent (479/727) of the study population was screened with a DWP prior to procedure. Of this population, a large majority (355, or 74%) did not require a pre-procedural GI clinic visit. Assuming an average of 30 minutes per pre-procedural visit, we estimated this accounted for a total of 177 hours of clinic time saved. Of the 479 cases scheduled by the direct access pathway, 120 (25%) had clear documentation of the DWP triage survey positively affecting patient care including adjustment of anticoagulation regimen (n = 29, 24%) and guidance on obtaining cardiac, renal, or pulmonary clearance (n = 23, 19%). CONCLUSION: The DWP triage survey utilized by our institution is an effective method to provide direct access endoscopy to a large population while eliminating unnecessary pre-procedural GI clinic visits for low-risk patients. The benefit of this intervention is evidenced by the estimated 177 hours saved per month. In addition, the DWP serves as a safety screen that allows for physicians and ancillary staff to make crucial adjustments that optimize patient safety prior to procedure. Strengths of this study include the large number of procedures analyzed and a wide distribution of MGUH endoscopists. Limitations of this study include lack of post-procedural safety outcomes.