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

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)

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

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

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

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

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

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

4. How many procedures are done in your clinic per year 4. How many procedures are done in your clinic per year? (21 clinics responded) Total Average/ Clinic Range Median/ Colonoscopies 65,528 3,120 156-22,250 2500 Gastroscopies 13,915 662 0-3,650 400 Sigmoidoscopies 7,948 418 0-6,050 50

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

15 of 19 clinics have unused procedure rooms for future expansion 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

7. How are your patients referred?

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

9. Indications for referral for endoscopy at your clinic.

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

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

12. Which colonoscopy prep do you most commonly use?

13. What sedation agents are used at your clinic?

14. What patient monitoring is performed?

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

16. Scope Reprocessing.

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

18. Are you an accredited with any organization?

19. Is your clinic involved in marketing or advertising?

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

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