Ambulatory Endoscopy in Ontario- Current Practice Patterns

1. Ambulatory Endoscopy in Ontario- Current Practice Patterns Doug Hemphill MD, FRCP(C) Barrie Endoscopy The Royal Victoria Hospital, Barrie, ON

2. 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 organization Ministry 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)

3. 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

4. Endoscopy Clinics in Ontario Albany Clinic Barrie Endoscopy Bluewater Surgical Centre Bray Brunswick Clinic Byrne Digestive Health Desai Downsview Endoscopy Durham Endoscopy Centre Elkashab Endoscopy Clinic of Greater Toronto Farmed Endoscopy Gastroenterology Group GTA Endoscopy Holly Street Endoscopy Intestinal Health Kensington Endoscopy Maple Endoscopy Missisauga Colonoscopy North Scarborough Endoscopy North Toronto GI Clinic North York Endoscopy Markham Endoscopy Oakville Endoscopy Centre Oshawa Clinic Endoscopy Ottawa Endoscopy Patel Polyclinic PES-Rudd Clinics SCOPE Clinic Surrey Clinic Toronto Clinic The Toronto GI Clinic Upper Canada Lower Bowel Vaughan Endoscopy West GTA Endoscopy

5. Endoscopy Clinics in Ontario Albany Clinic Barrie Endoscopy Bluewater Surgical Centre Bray Brunswick Clinic Byrne Digestive Health Desai Downsview Endoscopy Durham Endoscopy Centre Elkashab Endoscopy Clinic of Greater Toronto Farmed Endoscopy Gastroenterology Group GTA Endoscopy Holly Street Endoscopy Intestinal Health Kensington Endoscopy Maple Endoscopy Missisauga Colonoscopy North Scarborough Endoscopy North Toronto GI Clinic North York Endoscopy Markham Endoscopy Oakville Endoscopy Centre Oshawa Clinic Endoscopy Ottawa Endoscopy Patel Polyclinic PES-Rudd Clinics SCOPE Clinic Surrey Clinic Toronto Clinic The Toronto GI Clinic Upper Canada Lower Bowel Vaughan Endoscopy West GTA Endoscopy

6. 1. How many years has your clinic been in operation? (22 responses) Average 6.86 yrs Range 3 months to 40 years 11 Clinics 3 yrs or less

7. 2. How many doctors perform endoscopies at your clinic on a regular basis? (22 responses) General Surgeons 2.9/clinic 58 Total Gastroenterologists 3.43/clinic 72 Total Other 1 Number of Clinics GI only 5 Number of Clinics General Surgery Only 1

8. 3. What proportion (%) of doctors working regularly at your clinic have active hospital privileges? 100% hospital privileges 10 clinics 0% hospital privileges 6 clinics 20%-90% hospital privileges 6 clinics

9. 4. How many procedures are done in your clinic per year? (21 clinics responded)

10. 5. Can patients be referred for gastroscopy only (not associated with a colonoscopy)?

11. 6. How many procedure rooms at your clinic are used for endoscopy most days? 15 of 19 clinics have unused procedure rooms for future expansion

12. 7. How are your patients referred?

13. 8. Do patients have their procedure performed on the same day as the consultation?

14. 9. Indications for referral for endoscopy at your clinic.

15. 10. What types of co morbidity exclude patients from having procedures at your clinic?

16. 11. What therapeutic procedures do you perform at your clinic?

17. 12. Which colonoscopy prep do you most commonly use?

18. 13. What sedation agents are used at your clinic?

19. 14. What patient monitoring is performed?

20. 15. Nurses- what proportion are RNs vs. RPNs?

21. 16. Scope Reprocessing.

22. 17. What indicators of quality care do you regularly monitor and record?

23. 18. Are you an accredited with any organization?

24. 19. Is your clinic involved in marketing or advertising?

25. 20. Does your clinic charge patients a non-OHIP fee?

26. END