Endoscopy - Revision history

JenniferH at 01:26, 10 October 2020

2020-10-10T01:26:52Z

← Older revision		Revision as of 01:26, 10 October 2020
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	''(the [[Endoscopist Reference]] page describes queue management, pathology orders, etc.)''		''(the [[Endoscopist Reference]] page describes queue management, pathology orders, etc.)''


	Only diagnostic, screening, and surveillance endoscopy procedures are performed in Bethel. Patients needing therapeutic procedures, whether routine or urgent, require referral to a higher level of care.		Only diagnostic, screening, and surveillance endoscopy procedures are performed in Bethel. Patients needing therapeutic procedures, whether routine or urgent, require referral to a higher level of care.

	Endoscopy is only performed for low-risk patients. Therefore patients must meet the '''[[YKHC Low-Risk Endoscopy Criteria]]'''. The lower age-cutoff for endoscopy is variable and dependent upon the patient's anticipated anatomy as well as the endoscopist's comfort level. Most endoscopists are comfortable performing procedures on teens who have essentially adult anatomy, regardless of chronological age.		Endoscopy is only performed for low-risk patients. Therefore patients must meet the '''[[YKHC Low-Risk Endoscopy Criteria]]'''. The lower age-cutoff for endoscopy is variable and dependent upon the patient's anticipated anatomy as well as the endoscopist's comfort level. Most endoscopists are comfortable performing procedures on teens who have essentially adult anatomy, regardless of chronological age.


	===Outpatients===		===Outpatients===

	Screening, surveillance, and diagnostic procedures are offered for outpatients. Patients should be referred after their comorbidities are well controlled and meet the '''[[YKHC Low-Risk Endoscopy Criteria]]'''.		Screening, surveillance, and diagnostic procedures are offered for outpatients. Patients should be referred after their comorbidities are well controlled and meet the '''[[YKHC Low-Risk Endoscopy Criteria]]'''.


	===Inpatients===		===Inpatients===
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	The risk/benefit ratio for screening does not justify performing procedures when patients are below their baseline health status (which is almost certainly the case for any inpatient).		The risk/benefit ratio for screening does not justify performing procedures when patients are below their baseline health status (which is almost certainly the case for any inpatient).


	===EGD===		===EGD===
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	Like many circumpolar populations, Alaska Natives have a very high prevalence of gastric H. pylori and an alarming rise in drug resistance. This has major implications for the diagnosis and treatment of H. pylori in this populations. Please review the [[Helicobacter pylori in Alaska Natives]] page prior to diagnosing or treating H. pylori in this population.		Like many circumpolar populations, Alaska Natives have a very high prevalence of gastric H. pylori and an alarming rise in drug resistance. This has major implications for the diagnosis and treatment of H. pylori in this populations. Please review the [[Helicobacter pylori in Alaska Natives]] page prior to diagnosing or treating H. pylori in this population.



	===Colonoscopy===		===Colonoscopy===

	Diagnostic, screening, and surveillance colonoscopies are performed.		Diagnostic, screening, and surveillance colonoscopies are performed.


	===Urgent Cases===		===Urgent Cases===

	Endoscopy can be performed Monday through Friday. Urgent ''diagnostic'' cases, from either the ER or inpatient, can frequently be added for later in the day or the next morning. This is initiated by contacting the endoscopist. If unknown, the endoscopist availability and contact information can be found by paging the OR charge nurse.		Endoscopy can be performed Monday through Friday. Urgent ''diagnostic'' cases, from either the ER or inpatient, can frequently be added for later in the day or the next morning. This is initiated by contacting the endoscopist. If unknown, the endoscopist availability and contact information can be found by paging the OR charge nurse.


	===Viewing Endoscopy Images===		===Viewing Endoscopy Images===

	Images are [usually] processed and uploaded into the patient's chart at the end of the procedural day, but low staffing or emergency procedures can result in deviations from the normal routine. Images are uploaded as a PDF file into the Multimedia manager under the "Telemed/Clinical Photos" folder. The image filenames begin with "''EndoPics_''" followed by the date in the ''YYYYMMDD'' format. Double-click the file to view it in Acrobat Reader.		Images are [usually] processed and uploaded into the patient's chart at the end of the procedural day, but low staffing or emergency procedures can result in deviations from the normal routine. Images are uploaded as a PDF file into the Multimedia manager under the "Telemed/Clinical Photos" folder. The image filenames begin with "''EndoPics_''" followed by the date in the ''YYYYMMDD'' format. Double-click the file to view it in Acrobat Reader.


	==Endoscopy Orders==		==Endoscopy Orders==

AndyS at 03:55, 21 October 2017

2017-10-21T03:55:16Z

← Older revision		Revision as of 03:55, 21 October 2017
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	Diagnostic and surveillance EGD's are performed. Screening EGD's are controversial and should be discussed with an endoscopist prior to referral. If ordered, the referral should specify that the patient be scheduled with the endoscopist who has agreed to do the case.		Diagnostic and surveillance EGD's are performed. Screening EGD's are controversial and should be discussed with an endoscopist prior to referral. If ordered, the referral should specify that the patient be scheduled with the endoscopist who has agreed to do the case.

	Like many circumpolar populations, Alaska Natives have a very high prevalence of gastric H. pylori and an alarming rise in drug resistance. This is major implications for the diagnosis and treatment of H. pylori in this populations. Please review the [[Helicobacter pylori in Alaska Natives]] page prior to diagnosing or treating H. pylori in this population.		Like many circumpolar populations, Alaska Natives have a very high prevalence of gastric H. pylori and an alarming rise in drug resistance. This has major implications for the diagnosis and treatment of H. pylori in this populations. Please review the [[Helicobacter pylori in Alaska Natives]] page prior to diagnosing or treating H. pylori in this population.

AndyS at 02:03, 13 October 2017

2017-10-13T02:03:58Z

← Older revision		Revision as of 02:03, 13 October 2017
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	==~~ORDERING ENDOSCOPY~~==		==Endoscopy Orders==
	For patients who meet the [[YKHC Low-Risk Endoscopy Criteria]] and need a diagnostic, screening, or surveillance procedure, a Bethel endoscopy can be ordered with "''Refer to Adult Surgery Internal - YK EGD''" or "''Refer to Adult Surgery Internal - YK Colonoscopy''".		For patients who meet the [[YKHC Low-Risk Endoscopy Criteria]] and need a diagnostic, screening, or surveillance procedure, a Bethel endoscopy can be ordered with "''Refer to Adult Surgery Internal - YK EGD''" or "''Refer to Adult Surgery Internal - YK Colonoscopy''".

AndyS at 22:42, 12 October 2017

2017-10-12T22:42:33Z

← Older revision		Revision as of 22:42, 12 October 2017
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	Diagnostic and surveillance EGD's are performed. Screening EGD's are controversial and should be discussed with an endoscopist prior to referral. If ordered, the referral should specify that the patient be scheduled with the endoscopist who has agreed to do the case.		Diagnostic and surveillance EGD's are performed. Screening EGD's are controversial and should be discussed with an endoscopist prior to referral. If ordered, the referral should specify that the patient be scheduled with the endoscopist who has agreed to do the case.

			Like many circumpolar populations, Alaska Natives have a very high prevalence of gastric H. pylori and an alarming rise in drug resistance. This is major implications for the diagnosis and treatment of H. pylori in this populations. Please review the [[Helicobacter pylori in Alaska Natives]] page prior to diagnosing or treating H. pylori in this population.

AndyS at 00:20, 12 October 2017

2017-10-12T00:20:10Z

← Older revision		Revision as of 00:20, 12 October 2017
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	When ordering endoscopy, please provide as much information as possible in the '''comments''' tab of the order. Though a little more work at the time of the order might seem inefficient, it is even more inefficient when it must be done by a case manager and/or endoscopist who does not have the patient in front of them, the patient's chart open, or clairvoyance into the mind of the orderer.		When ordering endoscopy, please provide as much information as possible in the '''comments''' tab of the order. Though a little more work at the time of the order might seem inefficient, it is even more inefficient when it must be done by a case manager and/or endoscopist who does not have the patient in front of them, the patient's chart open, or clairvoyance into the mind of the orderer.

	The '''[[Example Endoscopy Orders]]''' page discusses ~~good,~~ efficient endoscopy orders.		The '''[[Example Endoscopy Orders]]''' page discusses efficient and effective endoscopy orders.

	For diagnostic procedures, please confirm that the patient has not already undergone the requested procedure for the same symptoms. For example, if the patient had an EGD 6mos and 18mos prior for the same dyspepsia symptoms, the likelihood of benefit from an additional EGD is exceptionally low. Alternatively, if a chronic condition has worsened and is associated with new, serious symptoms, then a repeat procedure is frequently indicated and the order should briefly describe the new symptoms and the date of the associated chart note[s]. In the case of ambiguity, please consult an endoscopist.		For diagnostic procedures, please confirm that the patient has not already undergone the requested procedure for the same symptoms. For example, if the patient had an EGD 6mos and 18mos prior for the same dyspepsia symptoms, the likelihood of benefit from an additional EGD is exceptionally low. Alternatively, if a chronic condition has worsened and is associated with new, serious symptoms, then a repeat procedure is frequently indicated and the order should briefly describe the new symptoms and the date of the associated chart note[s]. In the case of ambiguity, please consult an endoscopist.

AndyS at 21:30, 11 October 2017

2017-10-11T21:30:09Z

← Older revision		Revision as of 21:30, 11 October 2017
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	===EGD===		===EGD===

	Screening EGD's are controversial and should be discussed with an endoscopist prior to referral. If ordered, the referral should specify that the patient be scheduled with the endoscopist who has agreed to do the case.		Diagnostic and surveillance EGD's are performed. Screening EGD's are controversial and should be discussed with an endoscopist prior to referral. If ordered, the referral should specify that the patient be scheduled with the endoscopist who has agreed to do the case.


	===Colonoscopy===		===Colonoscopy===

	Diagnostic, screening, and surveillance colonoscopies are ~~offered~~.		Diagnostic, screening, and surveillance colonoscopies are performed.

AndyS at 20:25, 11 October 2017

2017-10-11T20:25:50Z

← Older revision		Revision as of 20:25, 11 October 2017
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	===Inpatients===		===Inpatients===

	Only ''diagnostic'' procedures are offered for inpatients. There should be sound rationale for why the procedure should not be postponed until the patient has been discharged and has returned to their normal baseline ~~state~~.		Only ''diagnostic'' procedures are offered for inpatients. There should be sound rationale for why the procedure should not be postponed until the patient has been discharged and has subsequently returned to their normal baseline health status.

	The risk/benefit ratio for screening does not justify performing procedures when patients are below their baseline health status (which is almost certainly the case for any inpatient).		The risk/benefit ratio for screening does not justify performing procedures when patients are below their baseline health status (which is almost certainly the case for any inpatient).

AndyS at 20:24, 11 October 2017

2017-10-11T20:24:27Z

← Older revision		Revision as of 20:24, 11 October 2017
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	Only diagnostic, screening, and surveillance procedures are performed in Bethel. Patients needing therapeutic procedures, whether routine or urgent, require referral to a higher level of care.		Only diagnostic, screening, and surveillance endoscopy procedures are performed in Bethel. Patients needing therapeutic procedures, whether routine or urgent, require referral to a higher level of care.

	Endoscopy is only performed for low-risk patients. Therefore patients must meet the '''[[YKHC Low-Risk Endoscopy Criteria]]'''. The lower age-cutoff for endoscopy is variable and dependent upon the patient's anticipated anatomy as well as the endoscopist's comfort level. Most endoscopists are comfortable performing procedures on teens who have essentially adult anatomy, regardless of chronological age.		Endoscopy is only performed for low-risk patients. Therefore patients must meet the '''[[YKHC Low-Risk Endoscopy Criteria]]'''. The lower age-cutoff for endoscopy is variable and dependent upon the patient's anticipated anatomy as well as the endoscopist's comfort level. Most endoscopists are comfortable performing procedures on teens who have essentially adult anatomy, regardless of chronological age.

AndyS at 20:23, 11 October 2017

2017-10-11T20:23:55Z

← Older revision		Revision as of 20:23, 11 October 2017
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	Only diagnostic, screening, and surveillance procedures are performed in Bethel. Patients needing therapeutic procedures, whether routine or urgent, require referral to a higher level of care.		Only diagnostic, screening, and surveillance procedures are performed in Bethel. Patients needing therapeutic procedures, whether routine or urgent, require referral to a higher level of care.

	Endoscopy is only performed for low-risk patients. Therefore patients must meet the '''[[YKHC Low-Risk Endoscopy Criteria]]'''.		Endoscopy is only performed for low-risk patients. Therefore patients must meet the '''[[YKHC Low-Risk Endoscopy Criteria]]'''. The lower age-cutoff for endoscopy is variable and dependent upon the patient's anticipated anatomy as well as the endoscopist's comfort level. Most endoscopists are comfortable performing procedures on teens who have essentially adult anatomy, regardless of chronological age.

	The lower age-cutoff for endoscopy is variable and dependent upon the patient's anticipated anatomy as well as the endoscopist's comfort level. Most endoscopists are comfortable performing procedures on teens who have essentially adult anatomy, regardless of chronological age.

AndyS at 20:23, 11 October 2017

2017-10-11T20:23:17Z

← Older revision		Revision as of 20:23, 11 October 2017
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	''(the [[Endoscopist Reference]] page describes queue management, pathology orders, etc.)''		''(the [[Endoscopist Reference]] page describes queue management, pathology orders, etc.)''

	~~===OVERVIEW===~~
	Only diagnostic, screening, and surveillance procedures are performed in Bethel. Patients needing therapeutic procedures, whether routine or urgent, require referral to a higher level of care.		Only diagnostic, screening, and surveillance procedures are performed in Bethel. Patients needing therapeutic procedures, whether routine or urgent, require referral to a higher level of care.