Increased demand for screening colonoscopy necessitates improved efficiency in endoscopy units, especially more efficient use of existing resources. The purpose of this study was to assess the efficiency of the endoscopy unit of a large tertiary care teaching hospital.
To assess the efficiency of the endoscopy unit in a large tertiary care teaching hospital.
Prospective study from May 16 to September 5, 2003.
Endoscopy unit of a 650-bed acute care teaching hospital.
Inpatient and outpatient procedures.
Time elapsed between endoscopic procedures; the duration of the procedures; procedure delays (>15 minutes between procedures) and the reasons for them.
The research assistant observed 675 endoscopic procedures done for 625 patients (207 inpatients [33%]). The most common procedure was colonoscopy (42.1%), followed by EGD (36.0%). Overall, procedures for 193 (30.9%) of the 625 patients were delayed (>15 minutes between procedures), 70.5% (136/193) because the physician was not available to start the procedure. The time elapsed between procedures was longer than 30 minutes for 47 of the 193 delayed procedures (24.4%). The duration of procedures was prolonged for about 22% (130/593) of procedures.
Physician unavailability contributed to considerable delays in endoscopic procedures. Strategies to reduce procedure delays could have a favorable impact on the volume of procedures performed in the unit, thereby improving the use of existing resources. We encourage other groups to assess the efficiency of their hospital-based endoscopy units.
Endoscopy is an integral part of the investigation and management of gastrointestinal disease. We aimed to examine outcomes of pregnancies for women who underwent endoscopy during their pregnancy.
We performed a nationwide population-based cohort study, linking data from the Swedish Medical Birth Registry (for births from 1992 through 2011) with those from the Swedish Patient Registry. We identified 3052 pregnancies exposed to endoscopy (2025 upper endoscopies, 1109 lower endoscopies, and 58 endoscopic retrograde cholangiopancreatographies). Using Poisson regression, we calculated adjusted relative risks (ARRs) for adverse outcomes of pregnancy according to endoscopy status using 1,589,173 unexposed pregnancies as reference. To consider the effects of disease activity, we examined pregnancy outcomes (preterm birth, stillbirth, small for gestational age, or congenital malformations) in women who underwent endoscopy just before or after pregnancy. Secondary outcome measures included induction of labor, low birth weight (
The rapid aging of the population constitutes a new challenge for the health care delivery system. This paper presents the progression of use of several diagnostic and surgical procedures in the elderly in Quebec from 1981 to 1989. Data were obtained from claims to the Régie de l'assurance maladie du Québec for the years 1981, 1985 and 1989. The rate of coronary artery bypass surgery increased by more than 700% in people 65 years and over between 1981 and 1989. This increase was especially high in the oldest age group (q 75 years). There was also a significant increase in surgery for abdominal aortic aneurysm, while the rate of carotid endarterectomy remained stable for people 65 years and over during this period. The rates of all abdominal surgical procedures examined (appendicectomy, repair of hiatal and inguinal hernia, cholecystectomy and colectomy) were relatively stable in elderly during the study period. Total hip replacement more than doubled in people 65 years and over, while other types of hip arthroplasty significantly decreased over this period. All types of diagnostic procedures examined (coronary angiography, bronchoscopy, gastroduodenoscopy and retrograd cholangio-pancreatography) increased significantly, especially in very old people. This study suggests that surgical care is increasing in the elderly in Quebec. This progression is expected to continue in the coming years so that surgical care of the elderly will become a significant part of our health care delivery system.