Thank you. Nice to get the rest of our panel back on camera, if they're able to, so we can do a few questions about this and other things that have come up. Maybe even if you want to kick us off. Yeah, absolutely. It'd be my pleasure. So Julie's had a question waiting since this has been going on for a long time. So I'm going to go ahead and pass it over to Dr. Levin. The question is, do your facilities have standardized start times and blocks? For example, everyone starts at seven 30 with a set number of blocks. So Dr. Levin, you want to kick us off? Well, if you're asking specifically about my facility. Yeah, we, we do have standardized start times. We do have a set number of blocks. We do have a set number of start times. We do have a set number of blocks. We do have a set number of start times. So we do kind of half a day and head to the office for the other half the day. While someone in the, in the. First half of the day might be in the office. So we split the day, but we are very standardized primarily because all of our staff are part of a union and all of their. Start times and end times and everything. It's all set by contract. So we're pretty rigid. Around that. We do have some physicians who are less than full time and they may. Have a half day off sometimes morning, sometimes afternoons. During the week, but. We do run on a kind of standard schedule. Dr. Did you want to add since you talked a little bit about this earlier? I'm sure. So. Where I'm at as well. We actually have a union. And so we do actually have block times, but I actually just recently. We did create a new block schedule for our entire unit. And we did take into account. Different start times and even varied, know, especially if people have childcare issues, or you know, whatever personal needs they may have, I do think it's reasonable to be flexible in terms of when to start. Jim, any nursing considerations? Since you're the representing the nurses here? Well, yes, we for ease of scheduling as well to be able to plan the day we do have standardized starting times for the morning session as well as the afternoon session. So this helps to ensure that we have the proper amount of support personnel on on hand in both, you know, the pre unit to prep as well as the procedure area and support the recovery of the patients. So it works, it works nicely for us. Of course, there's people who are fast, some that are slow. And it's that's how it's done. It is, it is one of the hardest things I've ever ever had to manage as a chief of a department was varying procedure lengths, but by position, sometimes it's by tenure, like people earlier in their career may be a little slower than people later in the career. And some people kind of almost regardless, they and, you know, these are people with good quality measures, they are on the higher end of ADR, but they're certainly the procedures are taking longer and staff are not necessarily happy because they they're getting the same number of procedures in a day as as someone who's going faster, and their days are tending a little longer. And it's tricky, it's hard to manage that. So we had another question about semester cone. So you know, it's there's kind of two pieces that I'm hoping to address on this, Dr. Levin, starting with you, this person specifically was asking, are there alternatives out there to some method cone? And then for our infection control faculty, if you can chime in and just remind folks on on the concerns around smetha cone. So I was not aware of any alternatives. Until you actually posed the question to me, I did a little Google search. And there's some herbal remedies, but I don't think any of them are as well evaluated as some ethical and certainly from a patient perspective. And for short term use, you know, just around the time of a procedure, I think smetha cone is pretty safe. I'm not really sure about the herbal alternatives. And Jim, any, anything you'd like to chime in about? I know, I think you're delivering it differently, right, Dr. Levin, like there's been some changes, there's two different ways to kind of get it to the patients and their prep and through the port. Is that right? Yeah. So we do give it, we have patients take it as part of their prep. We used to put it in the water bottle that was used for the back channel washing. And obviously Olympus and the other scope manufacturers, I think, are trying to avoid that practice because it can tend to form a biofilm in that back channel, and you can't brush that area at all. If you deliver it during the procedure, kind of using a syringe through the biopsy channel, that's also fine, because you're going to, you're still going to brush that area of the scope and so you'll cut down the biofilm formation. Any additional thoughts on that, Jim or Dr. De La Torre? Well, I know there's a product that that it was presented at SG&A this May, it's called GIEs, that's G-I-N, just E-A-S-E, GIEs, that's being utilized as a simethicone alternative. Our practice, we still utilize simethicone. It's only by our guidance is delivered through a syringe through the working channel of the endoscope due to the fact that, you know, it's brushable. And we have specified concentrations that are given. We do ask that the staff identify this endoscope as one that simethicone was used on when it does go through the disinfection process. These endoscopes are usually tagged for residual soil testing as well to ensure that we do one more measure to validate the cleanliness of the endoscope prior to disinfection. So our next, yeah, go ahead, please do. One question that I could sort of just want to pull the experts on the panel, you know, sort of tying a little bit in with what Joe was talking about, but, you know, also what TR was talking about earlier today, which is, you know, what is the panel done in terms of, you know, colon cancer screening outreach in populations that are underscreened? You know, we talked a little bit about how, you know, potentially more diverse workforce can get people in the door to get screened who might be unwilling. But that's a long term process and it doesn't happen overnight. And I know that, you know, many of the panel have had a good experience and work in urban areas in terms of, you know, trying to improve screening rates, which, to be fair, is good for patient care and also is good for the bottom line of the department or institution. So any sort of tips out there what people have been doing that have been effective in terms of improving cancer screening rates, especially in the underserved population? We've done some work in this area, but probably the number one thing that we've done that's been most effective for us has really been consistency and using a more of an organized approach to screening. You can kind of eliminate the role of unconscious bias if you set reminders and are asking your physicians to screen everyone and holding them accountable for that screening and also delivering invitations for screening. In our setting, that means FIT screening as kind of first line for people who haven't been screened and mailing the FIT kits to everyone's home, you know, regardless of, you know, color of their skin or race or ethnicity or anything else. And it's totally blind to all of those things. And then when people have a positive FIT, holding all the departments accountable for getting people in for their colonoscopy, regardless of, you know, race or ethnicity. And we've seen some narrowing of gaps, particularly in outcomes in terms of colorectal cancer, mortality and incidence between white and black patients over the, in our population, relatively insured population. We've tried to tailor some of our screening invitations to be more aligned or concordant in terms of race or ethnicity with people who are getting the invitation. So if we know someone's Latino, we have pictorial invitations for screening, featuring Latino members and same way with our African American patients, we use that and we also try and use, we do some robocalling and we try and have the robocalls done by an African American physician, reminding people that colon cancer is an important issue in our community. It doesn't have to be a gastroenterologist, could be a primary care doctor, it can be very effective. And same way we are aligning or collaborating with our Latino physicians as well to deliver those messages to the Latino members. So that's been pretty effective for us. I think the big, one of the big issues in barriers is really trust in the healthcare system. So that's where the alignment with what Joe was talking about earlier, you know, having physicians or staff that look like the patients that you're trying to reach is so important because they're more likely to have trust in someone who kind of looks like them. It's just kind of human nature. And also other things you can do to try and address the issues of trust in general. Raj, thank you. Thank you for asking that question. Because after spending the afternoon, literally talking about things like saving the planet, and deep considerations like DEI, I was, it felt wrong to end the day on Symethicone. But having said that, to my knowledge, we don't do anything differently at MUSC. Although we serve a large population of patients who have been traditionally underrepresented. What I do want to say, though, is that the ASG Quality Committee has just started an initiative, has just started a document focused on delivering high quality equitable care to traditionally underserved populations with the goal of developing key performance indicators, specifically to underserved patient populations. And so I'm hopeful that that document will be will be published in the next year or so. And I think I'm really excited about the implications of a document of this nature, because I think it's going to provide groups and practices, a framework of how to approach this more objectively and in a more structured way, as opposed to just saying, hey, we all want to do the right things. But the nuts and bolts of doing the right thing is not always super apparent. So many, many ideas like what what, you know, TR was just mentioning, I think will hopefully come through as key performance indicators, and things just, you know, as simple as ensuring that faculty, that patient face, sorry, patient facing staff and employees have adequate training and cultural competency. So, you know, TR, ideally, yeah, you want your doc and your nurse and everybody else to look like you. But you know, that's not feasible in many parts of the country. But what you do want is your your doc and your nurse to be sensitive to certain particular considerations that have over time, led to mistrust amongst underserved patient populations. And that can be achieved through training and education, but can also be achieved even by diversifying your unit a little bit, just by adding a few people with a different perspective, they will teach you more about cultural sensitivity, then then, you know, many, many educational modules. And so, you know, hopefully, and this is front and center on the on the quality committee's mind, and hopefully we will have deliverables that will be sort of practical and helpful to two units as they embark on this journey. Probably, I think you wanted to maybe say something, but I was just going to make one quick, you know, maybe positive note, which is that, you know, part of it, diversity is actually having the diversity, you know, people with diversity in leadership. And it sounds like from, you know, just the panel with Rabia and Nithika, you know, obviously, both leaders in their own units that shows some progress as well. Because I think you won't get that if you're just have the diversity, but no input in decision making, like you were saying, Joe. So now, now, Rabia has to say something super wise after I gave them a compliment. So go ahead, Rabia. I just to answer the the initial question about what we're doing for outreach. So I work at Bellevue Hospital, which, you know, serves one of the most underserved populations in the country, and its oldest public hospital in the country. And so we often think about, you know, what we can do, like you mentioned things in the endo unit, of course, you know, there's things you want to make do to make patients feel more comfortable once they're there. But that's the issue of getting them there. So we know that black men are 24% more likely to be diagnosed with cancer and 47% more likely than white men to die from it, which is really unfortunate. So how do we physically get them in the door to prep to see their PCP, first of all, and then prep and then actually undergo the procedure. And I think that's going to be the biggest kind of litmus test for actually like showing improvement. And so something I've always done in my career is like, okay, I think we sit and we think and we talk and we write papers about what we can do, but what are you physically doing on the ground. And so there's been some really great work out of UCLA on this and how to actually combat this issue. And there's also been several studies in and around New York City about where to target patient education. Is it black churches? Is it barbershops? There's a barbershop study where you're trying to enlist specifically black men to try and increase their screening rates. And I think that that is what type is that's what is needed community outreach to educate and make people feel more comfortable with the healthcare system, regardless of what your doctor might look like, which of course, in an ideal world, it would be great if everyone felt super comfortable. But that's, again, like Joe mentioned, not always possible. But we really need to get people into the endoscopy unit to actually get screened so we can save some lives. Now that we've addressed what the actual problem is, and we have to make ways to fix it. Yeah, I think that that is super helpful. And it's also important because you're describing, you know, when Joe talks about a document, right, which is important to write, how does the ASG help, you know, units implement what needs to be done, that implementation science that you're sort of doing at a, at a local level, is going to be really important. And so TR talked about, you know, what they're doing and what you're doing, I think these are big centers, you know, how do we help everyone else do this? And, you know, I think I learned a lot of what we need to do here. So sorry for hijacking us away from San Mateo. And I know that's always a fan favorite, but I'm slightly convinced that improving screening rates in, you know, blacks and Latinos might be more impactful than changing San Mateo to an herbal remedy. That's why you're the course director, and I'm not Dr. Kishwan. You never know though, Samantha Cohen is great. It is, it is a fan favorite question. So we do like to review it. Undereal us, Joe, and maybe close us up soon, right? I, we are past our time. So if you Dr. Kishwani and Dr. Elmanzer want to make some closing comments, and then I'll just wrap us up. Roger. You've always been the more eloquent of me, Joe. So as the as the chair of the quality committee, why don't you close this up. But I just want to thank everyone on the panel, especially and just really learned a lot. But go ahead, Joe, please. Yep. Mainly, thanks and gratitude for the audience, or to the audience and to the to the faculty to the SG staff who've made it a seamless experience. All in all, this was I think, my first quality course, but I'm already looking forward to the 45th offering. And it's it's been a real honor to be with you today. So with that, Eden, will you? Will you close us out? And I'm joking, just before you close that Eden, we have to thank you again, Eden, literally scripts our entire day to make sure that we try to stay on time. So she is your resource. Please, if you have any questions, always email her. She knows how to reach us as well. So thank you again, Eden for keeping us on track. You always make it a pleasure, as do you audience, I enjoy interacting with all of you leading up to these and during and afterwards. So I want to congratulate us all on a wonderful course. So our thanks to the faculty and to you, our participants. As a reminder, each of you will have ongoing access to the recordings from the course via GI leap ASG is online learning management system when they're available in roughly three to four weeks. So I know a lot of you've been trying to get in during the day, staff will be getting back to you. If we don't get back to you today, we'll get back to you on Monday about getting in and getting those slide decks. And just to make sure that you're in and you can see the recordings when they're available. The course evaluation is now available in GI leap as well. So that's why we want to get you in there as well. Once you complete it, you can download your certificate. If you need assistance logging into GI leap, please email quality at ASG dot o RG. This concludes the improving quality and safety in your endoscopy unit course. We hope this information is useful to you and your practice.

endoscopy units

simethicone

diversity in leadership

colon cancer screening rates

community outreach