When the Vancouver Island Health Authority opted to be the first region to roll out the province’s new colon cancer screening program in April, it did not anticipate how high the demand would be for colonoscopies.
“What we couldn’t gauge or didn’t have good modelling around was just how popular [it would be, and] how family doctors would embrace this new program, and that’s what’s exceeded our expectations,” said Dr. Thomas Dorran, VIHA’s executive medical director for Medicine, Emergency and Trauma Services and Renal Services.
VIHA’s South Island gastroenterologists say they can no longer take new patients because they cannot meet the increased demand for colonoscopies due to a lack of resources and access to facilities to perform the procedures.
“I think the pressure is on,” Dorran said. It’s a matter of “how do we do a better job with coping with increased demand and scarce resources.”
There were 25,433 colonoscopies performed last year across nine VIHA sites.
VIHA, through the provincial government, has budgeted $600,000 to provide an extra 1,600 colonoscopies this year, with one-time funding of $187,000 for another 500 to help with the backlog.
“The number of referrals from the outside to endoscopists has probably tripled,” Dorran said.
Specialists and family doctors are concerned the demand will only grow, while VIHA is wondering whether the demand will drop off.
Despite the challenges, Dorran said he is looking at every possibility — from what drugs are used to the scheduling of gastroenterologists — to expand access and use staff and resources more efficiently in order to perform as many screening procedures as possible.
Administration met recently to discuss expanding the hours of the endoscopy unit. In a colonoscopy, an endoscope is inserted to examine the large bowel and part of the small bowel and allows surgeons to look for or remove cancerous polyps or tumours.
“Senior staff is now looking at scheduling for evenings and weekend use,” Dorran said. “That’s a work in progress.”
VIHA also hired a full complement of endoscopy nurses in recent weeks to address a shortage. “As of last week, we are finally back up to our full staffing levels, which is great but now the challenge is … we have a bunch of nurses new to endoscopy.”
It takes up to six weeks to train and orient a registered nurse to work in the endoscopy unit, VIHA said.
The health authority is also adding more nurse navigators, also called patient co-ordinators, to direct the flow of patients requiring colonoscopies and sift out the referrals that may not be warranted, Dorran said.
Two full-time co-ordinators will be in place by mid-July for South Island hospitals. One full-time equivalent patient co-ordinator is already in place in the Central Island and an additional 0.5 FTE will be added next month, VIHA said.
Other challenges affecting the number of colonoscopies that can be performed was a renovation of the endoscopic suite at Victoria General Hospital, which saw a total of 200 fewer procedures performed from November through March.
As well, in November the introduction of the computerized Medical Health Record was rolled out at Royal Jubilee. When the pilot project is completed in the fall, the hospital’s endoscopy unit will be among the most automated in the country. However, in the meantime, “productivity is taking a hit,” Dorran said.
Dorran said the Island’s gastroenterologists are “phenomenal” and thinks if he were one of them, he, too, would feel “under the gun.”
“In some respects, they are the canary in the coal mine. They are just saying ‘Listen, we need to consider how we are doing business here and make some changes.’ ”
