1. Organized Diagnostic Assessment Demonstration Projects Organized Diagnostic Assessment Demonstration Projects Streamlined Centre for Out-Patient Endoscopy (SCOPE) Dr. Linda Rabeneck, Andrea Lombardi North York General Hospital, Sunnybrook Health Sciences Centre, Toronto East General Hospital Project Summary The project’s goal was to implement a central intake unit that arranges colonoscopies for eligible patients at one of the three collaborating hospitals: North York General Hospital, Sunnybrook Health Sciences Centre, and Toronto East General Hospital. Problem The journey for patients being screened for, or with suspected CRC is fragmented and uncoordinated. It is characterized by serial wait times – that may be lengthy - along the pathway from family physician referral to specialist (gastroenterologist or general surgeon) for consultation (wait 1) and from specialist consultation to the screening and diagnostic procedure, the colonoscopy (wait 2). These wait times are affected by: 1) whether the patient is seen in the office by a specialist; 2) physician waiting list management; and 3) how the hospital organizes the delivery of endoscopy services. Solution The central intake unit, called the Streamlined Centre for Out-Patient Endoscopy (SCOPE), streamlines the process from referral to colonoscopy (the screening and diagnostic procedure for colorectal cancer), thereby improving wait times for the procedure. Patients are introduced to the SCOPE through a family physician referral, if that patient has had a positive Fecal Occult Blood Test or has a parent, sibling, or child who has been diagnosed with colorectal cancer. Program Goals Goal: To establish a Diagnostic (and screening) Assessment Program to coordinate and expedite access to colonoscopy. Specific Objectives: For patients who are FOBT+, a wait time from family physician referral to colonoscopy of 30 days (1 month) or less; For patients who have a first-degree relative who has been diagnosed with CRC, a wait time from family physician referral to colonoscopy of 90 days (3 months) or less; Maintain or improve a patient satisfaction rating of 86.98% as determined by the PSQ III; Provide a standardized approach to the patient’s journey from family physician referral to colonoscopy. Program Impact 1.Wait Times: Wait times are measured by the time to procedure - the number of calendar days from the date the family physician’s referral is received by the specialist’s office to the date of the colonoscopy. The difference in the mean wait time for patients with an FOBT+ indication is 83.94 calendar days, representing a 78.29% reduction in the wait time from pre- to post-intervention. The 23.28 day mean post-intervention wait time also exceeds the 30 day project objective for this same indication. The difference in the mean wait time for patients with a family history indication is 130.07 calendar days, representing an 81.38% reduction in the wait time from pre- to post-intervention. The 29.76 day mean post-intervention wait time also well exceeds the 90 day project objective for this same indication. 2. Patient Satisfaction: The patient satisfaction survey utilized for this project was the Patient Satisfaction Questionnaire III, originally developed by Ware et al (1983), modified by Mark Dobrow (2006). Overall pre-Intervention score = 86.98% (n=45). Overall post-Intervention score =81.69% (n=37), The difference in the overall mean PSQ III score was 5.29%, representing a minor decrease from pre- to post-intervention. The difference in the mean pain scale rating was 0.22, representing a minor decrease from pre- to post-intervention. The above differences are negligible, thus indicating no significant change in patient satisfaction. Conclusions The main goal of the SCOPE is to streamline the process from family physician referral to colonoscopy for eligible out-patients, and to obtain pathology results in an expeditious manner. Simply put, the SCOPE standardizes the patient journey from family physician referral to colonoscopy. Top 3 Achievements 1.Three large Toronto hospitals coming together to collaborate in an innovative manner specifically, pooling endoscopy slots reserved for ColonCancerCheck patients, for the purpose of reducing patient waiting times for screening and diagnostic colonoscopies; 2.Reduction in patient waiting times from family physician referral to colonoscopy of over 78% for FOBT+ indications, and over 81% for family history indications; 3.The maintenance of patient satisfaction as demonstrated by the PSQ III. Top 3 Challenges 1.Family physician engagement; 2.Attempting to change family physician referring behaviour; 3.Obtaining sufficient referrals to the SCOPE while going live in late spring, and relying on the summer months to build the SCOPE’s referral volumes. Next Steps 1.Explore possibility of streamlining process from diagnosis to surgery 2.Explore expansion of nursing role