GI Unit Leadership: Shaping a High-Performing Endoscopy Unit (Virtual) | February 2026-ASGE white paper_Transportation Barriers

ASGE white paper_Transportation Barriers_sedation no ride

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This white paper from the American Society for Gastrointestinal Endoscopy (ASGE) Quality Assurance in Endoscopy Committee addresses transportation barriers faced by patients undergoing outpatient GI endoscopic procedures, which often require moderate to deep sedation. Standard practice mandates a responsible adult escort to accompany patients home due to concerns over impaired psychomotor and cognitive function post-sedation, yet some patients present unescorted, posing challenges to care delivery.<br /><br />The document reviews sedation recovery data, noting that propofol sedation leads to faster psychomotor recovery compared to midazolam but acknowledges limited real-world evidence, which underlies continued recommendations for post-procedure escorts. Reasons for unaccompanied patients include social isolation, logistical difficulties, privacy concerns, and misunderstanding of instructions.<br /><br />The paper details regulatory requirements from bodies like CMS and accreditation organizations that generally require responsible adult escorts, with some allowance for attending physician exemptions. Professional societies vary; most endorse escort requirements, though some acknowledge real-world challenges and propose alternative shared decision-making strategies.<br /><br />Medico-legal considerations are discussed, highlighting limited litigation history but emphasizing documented warnings and patient acknowledgment to mitigate liability. The key legal precedent is Young v Gastro-Intestinal Care, Inc., which ruled physicians fulfill duty of care when advising against driving post-procedure and securing patient acknowledgment.<br /><br />To address transportation barriers, the paper reviews alternative strategies such as solo discharge for selected low-risk patients (supported by Mayo Clinic data on safety), use of nurse's aides to escort patients home, ride-sharing or taxi services, prolonged post-anesthesia care stays, or short-term admissions, though these options vary in feasibility and medicolegal acceptance.<br /><br />The authors advocate proactive discharge planning starting at appointment scheduling, patient education, documented policies, and signed patient attestation forms to clearly communicate escort requirements and risks. Three clinical scenarios are considered for managing unescorted patients before, during, or after procedures, focusing on alternative testing or sedation plans and risk management consultations.<br /><br />In conclusion, as endoscopy volumes increase with expanded colorectal cancer screening guidelines, transportation barriers are an emerging challenge requiring tailored policies balancing patient safety, access to care, and medicolegal risk. Further research on psychomotor recovery assessment and validated discharge criteria is needed. Meanwhile, endoscopy units are urged to develop flexible, context-sensitive protocols that address social determinants of health and mitigate risks related to unaccompanied post-sedation patient discharge.

Keywords

gastrointestinal endoscopy

sedation recovery

transportation barriers

patient escort requirements

propofol sedation

medico-legal considerations

discharge planning

unaccompanied patients

risk management

colorectal cancer screening