Gibson Robert, Hitchcock Karen, Duggan Anne E
Gastroenterology Department, John Hunter Hospital, Newcastle, New South Wales, Australia.
J Gastroenterol Hepatol. 2006 Mar;21(3):569-71. doi: 10.1111/j.1440-1746.2006.04141.x.
Early endoscopic intervention reduces morbidity and mortality for patients with high-risk gastrointestinal hemorrhage and gallstones causing pancreatitis or ascending cholangitis. For low-risk bleeds 'after-hours' endoscopy services allow risk stratification and early, safe discharge leading to reduced length of stay. Recognized standards for these services include availability of endoscopically trained medical and nursing staff, access to a specialized endoscopy unit and full availability of the service. The aim of the present study was to assess 'after-hours' endoscopy services at Australian teaching hospitals using the British Society of Gastroenterology (BSG) criteria.
A standardized questionnaire based on the BSG guidelines was developed. The Gastroenterology Society of Australia provided a list of accredited sites for gastroenterology training. An advanced gastroenterology trainee at each hospital was interviewed by telephone.
Thirty-four centers (100%) provided complete data. Gastroscopy, colonoscopy and endoscopic retrograde cholangiopancreatography were provided in 100, 58 and 84% of centers, respectively. The operation suite followed by endoscopy unit was the most frequently used site. However, one-third of centers performed procedures at the bedside, including the emergency department or ward. Support staff were not consistently trained endoscopically and, in 15 centers (44%), the advanced trainees participated in the 'on call' roster with a consultant present for the procedure, although this was not consistently the case.
Most Australian hospitals offer comprehensive emergency endoscopy services. However, few centers fulfill all BSG recommendations. The registrar training and patient safety implications of emergency endoscopic services need to be considered in the light of these findings.
早期内镜干预可降低高危胃肠道出血以及胆结石引发胰腺炎或化脓性胆管炎患者的发病率和死亡率。对于低风险出血患者，“非工作时间”内镜服务可进行风险分层并实现早期安全出院，从而缩短住院时间。这些服务的公认标准包括配备经过内镜培训的医护人员、可使用专门的内镜科室以及服务全面可用。本研究的目的是使用英国胃肠病学会（BSG）标准评估澳大利亚教学医院的“非工作时间”内镜服务。
基于BSG指南制定了一份标准化问卷。澳大利亚胃肠病学会提供了经认可的胃肠病学培训地点清单。通过电话对每家医院的一名高级胃肠病学实习医生进行了访谈。
34个中心（100%）提供了完整数据。分别有100%、58%和84%的中心提供胃镜检查、结肠镜检查和内镜逆行胰胆管造影。最常使用的地点是手术室，其次是内镜科室。然而，三分之一的中心在床边进行操作，包括急诊科或病房。辅助人员未接受统一的内镜培训，在15个中心（44%），高级实习医生参与“值班”排班，操作时有顾问在场，不过情况并非始终如此。
大多数澳大利亚医院提供全面的急诊内镜服务。然而，很少有中心符合BSG的所有建议。鉴于这些发现，需要考虑急诊内镜服务对住院医生培训和患者安全的影响。
