Rideshare Provided by Health System Enabled Patients to Undergo Sedated Colonoscopy
Douglas K. Rex, MD, MASGE, reviewing Issaka RB, et al. Clin Gastroenterol Hepatol 2023 Oct 6.
Colonoscopy patients in the U.S. must generally guarantee they will have a responsible adult driver before scheduling a colonoscopy and confirm on arrival to the endoscopy unit that this driver is present. Many endoscopy units are reluctant to release sedated patients to medical transportation services, often because of fear of liability. Lack of transportation can prevent patients from undergoing colonoscopies.
A safety-net hospital in Seattle offered and covered the cost of a rideshare program for patients undergoing colonoscopy with moderate sedation who reported a lack of transportation and/or a chaperone.
Thirty-five patients gave informed consent, and 31 ultimately used the service. After the colonoscopy, an endoscopy nurse arranged transportation (Lyft Concierge) and escorted the patient to the vehicle. All rides were billed to the health care system.
All 31 patients arrived at their intended destination without incident. The average rideshare cost was $24.66, with a median distance of 2.05 miles and a median duration of 14.26 minutes. All participants said they could not have completed colonoscopy without the rideshare and would use it again and recommend it to others.
COMMENT
This study sets an important precedent for sedated patients who lack transportation to be safely transported home by a nonemergency medical transportation rideshare system. Studies of this type will help establish the safety and medical benefits of this practice and reduce the perceived legal liability.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Douglas K. Rex, MD, MASGE
CITATION
Issaka RB, Bell-Brown A, Hopkins T, Chew LD, Strate LL, Weiner BJ; Endoscopy Rideshare Work Group. Health system-provided rideshare is safe and addresses barriers to colonoscopy completion. Clin Gastroenterol Hepatol 2023 Oct 6. (Epub ahead of print (https://doi.org/10.1016/j.cgh.2023.09.030)
COMMENT
This study affirms important principles for FIT screening. First, cancers detected by FIT remain in an early stage during subsequent screening rounds. Further, increasing the cutoff level of hemoglobin for positive test results reduces sensitivity but does not shift the fraction of detected cancers substantially toward later-stage CRC. Thus, programs can adjust the cutoff to levels appropriate for their colonoscopy resources, and the detected cancers will be in an early stage across a range of hemoglobin thresholds for positive tests.