Characteristics of Australian after-hours emergency endoscopy services

Background and Aim: 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. Methods: 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. Results: 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. Conclusions: 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.