GI Unit Leadership: Optimizing Endoscopy Operations through Leadership (Virtual) | February 2025-ASGE white paper_Transportation Barriers

ASGE white paper_Transportation Barriers_sedation no ride

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The American Society for Gastrointestinal Endoscopy (ASGE) released a white paper addressing transportation barriers related to endoscopic procedures. With millions of GI endoscopies performed annually in the U.S., the practice often requires sedation, necessitating that patients be escorted by a responsible adult post-procedure due to delayed psychomotor recovery. However, this requirement often acts as a barrier for timely healthcare access, as social factors like increased single-residence households and social isolation impact patients' ability to arrange transportation, with up to 62% of patients facing negative impacts.<br /><br />The paper specifies five key objectives: outlining recovery patterns from sedatives, analyzing psychosocial factors for unescorted patients, reviewing regulatory and legal opinions, discussing various solutions implemented in the U.S., and providing practical recommendations for mitigating transportation issues.<br /><br />Post-sedation recovery is typically faster with propofol-based sedation, yet real-world evidence is limited mostly to simulator studies, so patients are advised to avoid complex tasks like driving until the next day. Transport obstacles may be overcome by alternative approaches, such as non-sedated procedures, using certified nurse's aides, or exploring ride-share services.<br /><br />While national regulations, like those from the CMS, generally require patients to be discharged with a responsible adult, discrepancies in interpretation exist across professional societies. Legal precedents, like Young v Gastro-Intestinal Care, Inc, suggest that clear pre-procedure communication protects providers when patients fail to comply with transportation advice.<br /><br />ASGE encourages early discharge planning, ideally at appointment scheduling, to identify and address potential transport challenges in advance. By proactively tackling these barriers, endoscopy units can ensure better compliance with health policies while safeguarding patient safety and access to necessary procedures.

Keywords

ASGE

endoscopic procedures

transportation barriers

sedation recovery

psychosocial factors

legal opinions

ride-share services

discharge planning

patient safety

healthcare access