title: Strategies to address increased demand for colonoscopy: Guidelines in an open endoscopy practice.
abstract: OBJECTIVE
  Since Medicare approval for reimbursement of screening colonoscopies, the number of colonoscopy requests has increased. Physician resources have often been inadequate to meet the demand. We sought to reduce the demand for colonoscopy in an open endoscopy system by using a guideline-based triage system to eliminate inappropriate procedures and to align the timing of surveillance colonoscopies with recommendations made by national organizations.
  
  
  METHODS
  This was a cohort study with primary care outpatients. From October 2002 to February 2003, 498 consecutive patients on a waiting list of 2400 awaiting colonoscopy for all indications were triaged and are the focus of the study. Selection of patients for appropriate colonoscopy was based on consensus guidelines developed for institutional use by using established published guidelines for appropriate colonoscopy indications.
  
  
  RESULTS
  Of the 498 consecutive patients triaged, 139 (28%) were deemed inappropriate. The most common reason was inappropriate referral for surveillance of colorectal polyps. The percentage of inappropriate referrals by the 3 largest referring specialties (internal medicine, family medicine, and gastroenterology) combined was also 28% with no statistically significant differences between specialties.
  
  
  CONCLUSIONS
  Most referrals for colonoscopy in an open-access endoscopy system were appropriate, although about 1 in 4 were not. Use of triage and further education of physicians regarding colonoscopy may optimize colonoscopy utilization.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Foundation, Scottsdale, Arizona, USA. baron.todd@mayo.edu
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.forename: Brenda D
authors.initials: BD
authors.lastname: Kimery
authors.forename: Darius
authors.initials: D
authors.lastname: Sorbi
authors.forename: Linda C
authors.initials: LC
authors.lastname: Gorkis
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Leighton
authors.forename: David E
authors.initials: DE
authors.lastname: Fleischer
mesh_terms: D015331:Cohort Studies; D003113:Colonoscopy / Q000592:standards* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D014218:Triage / Q000379:methods; D019564:Unnecessary Procedures