[maltmom3]

I am an LPN working in a GI office. The Gi MD is looking into offering Open ACcess Colonoscopies. I would like to hear from anyone with this type of experience, whether it's from an office experience or from the eno suites. My position would be screening the pts via phone. The pt's would be referred by their pcp. Thanks in advance. GI JO

[DutchgirlRN]

Originally Posted by maltmom3

I am an LPN working in a GI office. The Gi MD is looking into offering Open ACcess Colonoscopies. I would like to hear from anyone with this type of experience, whether it's from an office experience or from the eno suites. My position would be screening the pts via phone. The pt's would be referred by their pcp. Thanks in advance. GI JO

I don't know what an open access colonoscopy is???

[core0]

Originally Posted by DutchgirlRN

I don't know what an open access colonoscopy is???

Open access colonoscopy means that anyone who wants a colonoscopy gets one without a visit with a provider first. They schedule the colonoscopy and the first time anyone sees them is right before the procedure. Obviously you need someone to screen the patients for heart problems, anti-coagulation etc. I'm assuming thats what the OP is talking about.

Our office was one of the few in our market that did not do this. There were a couple of reasons for this. One is that our referring physicians rebelled. There needs to be some kind of H&P on the chart by JACHO rules. If you consider that it takes 5 minutes or so to do an H&P form then if you are sending 12 people a week that is one hour of uncompensated time per week. Bigger practices it gets worse. Some practices do this right before the colonoscopy but that risks missing something and takes away from endoscopy time.

The other reason is that you generate 1 upper procedure for every eight or so screening visits. That is additional revenue that the clinic misses with direct access.

Finally there is a direct correlation between the patients knowing relationship with the provider and lawsuits. If you spend some time with the patient there is less likelihood of being sued. Part of it is you have a better understanding of the patient and part of it is the patient has more realistic expectations of what they are going through. My former practice was two standard deviations below the average for claims over five years which resulted in malpractice saving of $5-6k per physician.

David Carpenter, PA-C

[DutchgirlRN]

Thanks for the explanation. Our hospital definately does not do open access colonoscopy's. I do think seeing a GI before scheduling the colonoscopy is very important.

[core0]

Originally Posted by DutchgirlRN

Thanks for the explanation. Our hospital definately does not do open access colonoscopy's. I do think seeing a GI before scheduling the colonoscopy is very important.

I would agree, that being said I believe that most colonoscopies are being done under open access. My opinion is that open access isn't good medicine but thats not what happens.

David Carpenter, PA-C

[maltmom3]

As a nurse Many of the pt's that I screen before the MD sees the pt are generally healthy. THe doc's spend very little time in the room with the pt completeing an assessment. Granted there are pt's that for obvious reasons fall into another category and should be evaluated by the md. As far as consent/risk factors forms are given and explained. I ask them to read over and ask questions when the MD comes in. These same risk factors are explained to them by the endo nurse.prior to the procedure. THe pts that would be scheduled for this would then be evaluated in the endo suites by the MD prior to the procedure. The pt will also be given the option to see the MD during a regular appt time if they wish. I hope there is further input from others on this subject. GI JO

[maxm]

our gi unit does " on demand" endoscopy and it seems to work really well for most patients and saves them a clinic visit. these patients have to be relativly healthy and most of them are screening colonoscopies. ther is a form, an H and P that needs to be completed on arrival and the doctor must do a full assessment. if you check the johns hopkins website and look under the department of gastroenterology, there is a nice form as well as their reccomendations for open access endoscopy. it looks like a good reference tool.

[dawnd123]

Open access endoscopies...very interesting...had never heard of this, but seems risky considering all the patients out there who have hx of cardiac surgery, anticoagulation, diabetes, renal problems, etc. How could everyone be on the same page for procedure if pt was only seen for 10 minutes 3 days ago and now here for procedure? dawnd123