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96 DISCHARGE PLANNING POSTENDOSCOPIC SPHINCTEROTOMY: A SURVEY OF CURRENT PRACTICE IN ONTARIO CJD Vanderspek, DR Martell, TP Ponich OBJECTIVE: Our goal was to perform a 10-year follow up study describing discharge planning practices postendoscopic sphincterotomy in Ontario. We expected that increase in use of therapeutic ERCP and in literature on complications has decreased post-ES admissions by endoscopists in Ontario over the past 10 years. We also expected that criteria for admission have become more uniform across the province despite continued variability in training, hospital characteristics and experience.
London Health Sciences Centre, London, Ontario
METHODS: We surveyed 105 Ontario physicians who perform ERCP. The survey dealt with aspects of ERCP including whether procedures are offered on an inpatient or outpatient basis, the approximate percentage of patients admitted post-ES, the criteria used as absolute or relative indications for admission and predischarge monitoring. The survey also determined endoscopist experience, specialty and hospital characteristics. We compared these results with results from a similar survey completed 10 years ago.
RESULTS: Our response rate was 55% (58). Three of the returned surveys were excluded from the study because they were incomplete. All respondents offer outpatient ERCP and ES. They admit a mean of 10% of patients following ES (SD 14%) in comparison to the mean admission rate of 27% ten years ago. The five most common absolute criteria for admission were evidence of perforation (82%), uncontrolled/difficult to control bleeding (75%) persistent pain (44%), pre-existing cholangitis (38%) and pre-existing pancreatitis (33%). Ten years ago, the five most popular absolute criteria were evidence of perforation (100%), pre-existing cholangitis (63%), persistent pain (59%), coagulopathy (50%) and difficult to control bleeding (49%). Endoscopists monitored patients between zero and four hours (mean 2.7 h, SD 1.12 h) before discharge. None of the responding endoscopists routinely measured serum amylases before discharge.
CONCLUSIONS: Admission practices continue to be variable across the province. Overall, endoscopists have decreased the percentage of admissions post-ES in the past 10 years. Though the results suggest that evidence of perforation is no longer a universal absolute indicator for admission, in general, endoscopists are using similar criteria as a decade ago in deciding which patients to admit.