OPEN ACCESS ENDOSCOPY FOR HOSPITALIZED-PATIENTS

Objectives: Most requests for gastroenterology consultations for hospi talized patients are for endoscopic procedures. Open access endoscopy has been evaluated in several institutions for outpatients. Our aim wa s to evaluate an open access policy for hospitalized patients. Methods : Since April of 1996, patients hospitalized in the Soroka Medical Cen ter have been referred directly for upper endoscopy (esophagogastroduo denoscopy, EGD) and flexible sigmoidoscopy (FS). The numbers of proced ures and consultation requests between July 1, 1996, and September 30, 1996, were compared with the corresponding months of 1995. A survey o f physician satisfaction with the new open access system was conducted . Results: The mean number of monthly consultations during the study p eriod was 30.7 +/- 2.4, compared with 119.3 +/- 5.4 during the same mo nths in 1995 (p = 0.006). Open access endoscopy was performed on 114 p atients during the study period. Upper GI bleeding (n = 41) and abdomi nal pain (n = 33) were the most common indications for EGD. There were nine duodenal ulcers, five gastric ulcers, and eight gastric carcinom as. Sixteen patients (21%) had normal EGDs. The most common indication s for FS were rectal bleeding (n = 24) and diarrhea (n = 13). Seven pa tients had colorectal cancer; 12 FSs were normal. In all, 286 EGDs and FSs were conducted in the study period compared with 253 in 1995 (not significant). All physicians expressed satisfaction with the new syst em and favored its continuation. Conclusions: The open access policy f or hospitalized patients led to a considerable reduction in requests f or consultations, with no significant increase in the number of endosc opies. The majority of patients referred directly for endoscopy had ap propriate indications.