Improving Quality and Safety in the Endoscopy Unit (On-Demand) | October 2024-13_Levin

13_Levin _Transportation Barriers

Pdf Summary

The white paper by Dr. T. R. Levin and colleagues addresses the issue of transportation barriers in gastrointestinal (GI) endoscopic procedures, particularly focusing on the dilemma faced by adults who undergo sedation yet cannot secure a responsible adult to escort them home. This is a widespread issue as millions of procedures requiring sedation, such as EGD and colonoscopies, are performed annually. The Centers for Medicare & Medicaid Services (CMS) requires that patients be discharged in the company of a responsible adult post-sedation, creating a barrier for those unable to arrange transportation.<br /><br />The paper highlights the complexity of defining a "responsible adult" and identifies societal changes, such as decreased inter-generational living and increased mobility, as contributors to this problem. Moreover, the lack of systematic data on patient behavior post-ambulatory endoscopy is noted, with reflections on international surveys indicating significant patient independence often in the absence of an escort.<br /><br />Legal implications are discussed with references to the case of Young vs. Gastrointestinal Center, which illustrates the medicolegal risks associated with letting unsupervised patients leave against medical advice. The case also underscores the limitations imposed on medical facilities in ensuring patient safety post-discharge.<br /><br />The paper proposes several potential solutions, such as the use of taxi or ride-share services and prolonged observation periods, and stresses the importance of engaging local risk management teams to craft tailored solutions. The paper suggests maintaining thorough documentation to protect against potential litigation and advises creating a proactive policy for handling lack of transportation scenarios.<br /><br />Ultimately, while legal and procedural frameworks guide medical practice, the authors acknowledge that no absolute solution exists, emphasizing that comprehensive local policies and risk management strategies can mitigate some of these challenges.

Keywords

transportation barriers

gastrointestinal procedures

sedation

responsible adult

Centers for Medicare & Medicaid Services

patient discharge

medicolegal risks

endoscopy

ride-share solutions

risk management