Esophagogastroduodenoscopy and primary care physicians: evaluation of a rural hospital EGD program.

Esophagogastroduodenoscopy (EGD) has been recognized as a useful procedure in the management of patients with upper gastrointestinal (UGI) disorders. This article describes the implementation of a rural hospital EGD program. The 40-bed Whiteriver Service Unit (WRSU) has no intensive care unit or surgical capabilities. In January 1992, on site endoscopy services began. The Contract Health Services (CHS) registers, emergency room logs, and transport logs were reviewed for the period January 1991 through July 1995. In addition onsite endoscopy logs, medical records, and biopsy reports were reviewed for January 1992 through July 1995. In the absence of onsite services, 33 patients were referred to outside facilities for EGD services in calendar year 1991. Sixteen patients (48 percent) were flown emergency with the diagnosis of upper gastrointestinal bleeding. The average CHS expenditure (after third party reimbursement) for UGI bleeding patients, including air transport, was $9,300 per patient. During the same year, 17 patients were scheduled for outpatient, elective upper endoscopy procedures. The show rate for the procedures was 53 percent (9 of 17 patients). The average CHS cost per patient in this group was approximately $600. From January 1992 through July 1995, 229 EGD procedures were performed at WRSU, with an average an average of 64 endoscopies per year. The authors note that establishment of on site EGD services appears to produce a significant reduction in outside referrals with parallel savings of CHS funding. The complication rate during the study period was 0.44 percent, consistent with the low complication rates from larger reviews. The single, equipment-related, complication occurred early in the first month of the program and was followed by 220 successful, uncomplicated procedures.