Closed Access Colonoscopy

Abstract

Purpose: Presently, patients referred for colonoscopy at our institution are required to have an initial encounter (closed access). Due to the clinic backlog for appointments, this initial visit may take up to three months. There is an additional wait time from the clinic visit to the colonoscopy. The concern was that the initial physician clinic visit might reveal a finding that would significantly impact the procedure preparation or performance. The aim of this study was to determine if the wait time, from consultation request to colonoscopy, could be reduced by eliminating the initial clinic visit. It was postulated that instead of a formal clinic visit, a medical provider could review the request for appropriateness, speak with the patient over the phone, and then schedule the colonoscopy. Methods: The records of all patients having colonoscopy for the calendar year, 2004, were reviewed. Inpatient colonoscopies, repeat colonoscopies, and inflammatory bowel patients were excluded. This left 786 patients who had consultations prior to their colonoscopy. The goal was to determine if any recommendations, other than a colonoscopy, were made during the initial consultation, and if such changes required physician input. The primary endpoint was the number of GI clinic patients whose treatment plan was simply “colonoscopy”. Secondary endpoints were the average wait time for a GI consultation and for a colonoscopy. Results: 529 of the 786 (67%) consultations did not result in any interventions during the clinic visit other than recommending colonoscopy. 197 (25%) patients had some type of intervention, other studies, labs, or adjustment of medications. The remaining 60 (8%) patients had their GERD addressed, in addition to ordering a colonoscopy during the consultation. The average wait from the request of the consultation to the clinic visit was 107 days. The time from clinic to colonoscopy was 109 days. Therefore, the total wait time from initial request to the actual colonoscopy was approximately 7 months. Conclusions: Our closed access system appears to be inefficient since more than 2/3 of the patients did not benefit from the mandatory consultation prior to scheduling the colonoscopy. The average wait time of 7 months for a colonoscopy is worrisome, especially for patients who subsequently had significant pathology diagnosed by their colonoscopies. Patients could be better served by having the consultation request reviewed by a medical provider and referred directly to colonoscopy when appropriate. This would immediately reduce wait time by half.