Bramble M G, Cooke W M, Corbett W A, Cann P A, Clarke D, Contractor B, Hungin A S
Department of General Medicine, Middlesbrough General Hospital, Cleveland.
Gut. 1993 Mar;34(3):422-7. doi: 10.1136/gut.34.3.422.
Increasing demand for upper gastrointestinal endoscopy has forced many clinicians to reconsider the policy of seeing all patients in a specialist clinic before gastroscopy. The following are considered essential in setting up an open access gastroscopy service. (1) Assessment of the need by examination of waiting times for the outpatient clinic and the proportion of patients requiring upper gastrointestinal endoscopy, and consultation with colleagues in general practice. During the first 2 years of the service the average waiting time for a medical gastrointestinal outpatient appointment has fallen from over 120 days to 37 days in this area. (2) An adequately staffed and equipped gastrointestinal unit with well motivated nurses (the workload will increase) and sufficient clinical support to allocate patients to the next available gastroscopy list is vital. A safe mechanism for relaying information back to the GP (including histology reports) is essential otherwise medicolegal problems could arise. Open access gastroscopy now accounts for 29% of the total endoscopy workload in South Tees. (3) Close cooperation between medical and surgical gastroenterologists must be achieved to ensure a uniform approach to the provision of this service and equal distribution of the endoscopy workload. This will require close examination of the potential numbers and may necessitate appointment of a clinical assistant or additional consultant. Clinical assistants perform just over 50% of the open access gastroscopies in South Tees and the waiting time has been kept short (average 17 days). (4) A comprehensive request form with guidelines for GPs and a specific box identifying whether the GP requires a report and brief advice only or follow up at the discretion of the endoscopist (often a clinical assistant) is required. (5) Management must be involved in identifying adequate resources. (6) Methods of monitoring requests and outcome measures to ensure effective audit must be established.
对上消化道内镜检查需求的不断增加，迫使许多临床医生重新考虑在胃镜检查前让所有患者在专科门诊就诊的政策。以下几点被认为是建立开放式胃镜检查服务的关键要素。（1）通过检查门诊等待时间以及需要上消化道内镜检查的患者比例来评估需求，并与全科医生同事进行协商。在该服务开展的前两年，该地区内科胃肠门诊预约的平均等待时间已从超过120天降至37天。（2）配备充足人员和设备的胃肠科，要有积极性高的护士（工作量将会增加）以及足够的临床支持，以便将患者分配到下一个可用的胃镜检查名单，这至关重要。建立一个将信息反馈给全科医生的安全机制（包括组织学报告）必不可少，否则可能会出现医疗法律问题。目前，开放式胃镜检查占南蒂赛德地区内镜检查总工作量的29%。（3）内科和外科胃肠病学家之间必须密切合作，以确保提供此项服务的方法统一，内镜检查工作量分配均匀。这将需要仔细审查潜在数量，可能还需要任命一名临床助理或额外的顾问。在南蒂赛德地区，临床助理完成了超过50%的开放式胃镜检查，且等待时间一直保持较短（平均17天）。（4）需要一份有全科医生指南的综合申请表，以及一个特定的方框，用于确定全科医生是仅需要报告和简要建议，还是由内镜医生（通常是临床助理）酌情进行随访。（5）管理层必须参与确定充足的资源配备。（6）必须建立监测申请和结果指标的方法，以确保进行有效的审计。
