Improving Quality and Safety in the Endoscopy Unit (On-Demand) | October 2024-ASGE Transportation Barriers white paper

ASGE Transportation Barriers white paper

Pdf Summary

The American Society for Gastrointestinal Endoscopy's Quality Assurance in Endoscopy Committee has prepared a white paper that addresses transportation barriers relating to gastrointestinal endoscopic procedures. This comprehensive document examines legal challenges, psychosocial factors, recovery patterns from sedatives, and suggests strategies to mitigate risk within GI endoscopy units. <br /><br />Transportation is a recognized barrier, affecting up to 62% of patients seeking timely healthcare, due in part to the standard requirement for patients undergoing sedation to be accompanied home by a responsible adult. This stipulation has sparked discussions about its necessity, as some patients lack a readily available escort due to societal changes like greater social isolation and increased individualistic living patterns.<br /><br />The paper reviews sedation recovery, noting that while evidence suggests that psychomotor function returns quickly with propofol sedation, professional guidelines continue to recommend that patients refrain from cognitively demanding tasks post-procedure. Legal precedents and policies require Medicare-certified facilities to ensure patients are discharged with an adult escort, although exemptions can be granted. Concerns exist about the medicolegal risks and potential patient compliance issues when these standards are not met.<br /><br />It explores alternative solutions like utilizing solo discharge, nurse aides, and rideshare services, and emphasizes proactive discharge planning initiated during appointment scheduling. It proposes stringent documentation to mitigate legal risks when patients fail to comply with discharge instructions.<br /><br />The paper concludes that developing local policies to accommodate unescorted outpatient procedures may ensure broader access to care without compromising patient safety, especially considering increased demand and potential screening needs for colorectal cancer. The document calls for further research to establish robust tests evaluating recovery and psychomotor function to enhance patient safety and access to GI procedures.

Keywords

Gastrointestinal Endoscopy

Transportation Barriers

Sedation Recovery

Legal Challenges

Patient Safety

Discharge Planning

Psychosocial Factors

Medicare Policies

Rideshare Services

Colorectal Cancer Screening