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Hospital use of routine sigmoidoscopy
Hospital
Use of Routine
Sigmoidoscopy
ALAN B. CAMERON, M.D., Columbus, Ohio From tbe Department oj Surgery, Medical Center, Columbus, Obio.
PERSONNEL
Obio State University
A senior medica aid is in charge of the sigmoidoscopy room. Besides maintaining the equipment, she aIso scheduIes examinations, administers enemas, transports patients and assists at sigmoidoscopy. Patients are scheduIed at forty-five minute-intervals. The medica1 aid’s saIary at Ohio State University Hospital is about $ I .50 an hour. The cost of the medica aid’s time per examination then is about $1.12.
ROCTOSIGMOIDOSCOPY combined with digita recta1 examination is the best method of detecting benign and early maIignant Iesions of the rectosigmoid. For this reason the Department of Surgery at Ohio State University Hospital estabIished proctosigmoidoscopy five years ago as part of the routine physica examination offered to surgica1 patients. An outIine of our procedure for routine and indicated proctosigmoidoscopy is presented herein. The cost is low in time and money. Because of this we hope other hospitals wiII be interested in estabIishing simiIar programs. By impressing the house staff and medica students with the ease and vaIue of routine sigmoidoscopy, our program aims to encourage them to use the examination in their future practice. This would greatly reduce the incidence and mortaIity of carcinoma of the rectosigmoid [r-3].
P
PROCEDURE Each patient is scheduIed at Ieast one hour prior to examination. The medica aid administers a disposabIe enema forty-five minutes prior to examination. This is the only preparation required, and it takes about five minutes of the aid’s time. The approximate cost of the enema unit is 33 cents [4]. Thirty minutes after evacuation of the
EQUIPMENT
TABLE I EQUIPMENT
On the surgical floor at Ohio State University HospitaI, a treatment room, IO by 16 feet in size, was converted for proctosigmoidoscopy. The equipment purchased is itemized in TabIe I. Two items on this Iist are expensive. The proctologic tabIe now costs about $600. Its advantage over a Iong tabIe or stretcher cart (cost about $200) is that it aIlows for versatiIity in positioning the patient for sigmoidoscopy and for pelvic examination. The portable suction apparatus costs about $450. Its advantage over Iess expensive table units is that it can be moved easity for suction purposes in other areas when it is not empIoyed in the sigmoidoscopy room. The total cost of the equipment is about $2,000. If this is entireIy written off on the first 10,000 proctosigmoidoscopic examinations, the cost of equipment per examination would be 20 cents.
NEEDED
FOR
Proctologic tabIe Instrument cabinet Dressing carriage Instrument tabIe Suction machine Metal swivet stooI Foot stoo1 3 Large scopes z Medium scopes 2 SmaII scopes 12 Extra batteries 24 Extra buIbs 2 Battery holders 2 Suction tips 2 Biopsy forceps I Anoscope 6 Recta1 specuIums 2 Recta1 probes Long cotton swabs
307
American
Journal
PROCTOSIGMOIDOSCOPY
ROOM
Anesthetic ointment Lubricating jelly Emesis basin Round basin Plastic basin, I I by 14 inches MetaI pan, I I by 14 inches Biopsy specimen bottIes 32 Ounce bottle of H aIcoho1 and J6 ether I GaIIon of Zephiran I GaIIon of SpaI detergent Rectal gloves Draw sheets Hand towels 6 PiIIow cases I Record book I ScheduIing book 12
12
oj Surgery.
Volume
~9. March,
1960
Cameron asymptomatic patients have poIyps. Of these, 15 per cent show histologic evidence of maIignancy. In addition, about one in 200 have a previousIy unsuspected maIignancy in the rectosigmoid [5]. This yieId of definiteIy precancerous and cancerous Iesions is much Iarger than the yieId of such lesions of the cervix discovered by routine cervica1 and vagina1 smears [6J.
enema, the sigmoidoscopy aid brings the patient to the examination room. He is pIaced in the position desired by the sigmoidoscopist at the time scheduIed for the examination. The physician arrives at this time and performs the examination. This usuaIIy requires about ten minutes. He is then free to return to other duties. This feature has been very popuIar with the busy attending and house staff. The medica aid assists the sigmoidoscopist by handIing swabs, instruments and the suction apparatus. After the examination the medica aid returns the patient to his room. She then administers an enema to the next patient, and returns to clean the room and equipment.
SUMMARY
Reduction in the incidence and mortality of carcinoma of the rectosigmoid may be accompIished by widespread use of routine proctosigmoidoscopy. A detaiIed low-cost program is presented for performing such examination on hospita1 patients. By giving house staff and medical students experience with the examination it is hoped they wiI1 use it routineIy in their future practice.
COST
As itemized previousIy, the approximate cost of sigmoidoscopy per patient is $I .65. This is Iess than the cost of a routine blood count in most hospitals.
REFERENCES
COMMENTS I. PORTES, C.
and MAJARARIS, J. D. Proctosigmoidoscopy-incidence of poIyps in 50,000 examinations. J. A. M. A., 163: 411-413, 1957. 2. WILSON, G. S., DALE, E. H. and BRINES, 0. A. Detection of poIyps in 20,847 routine sigmoidoscopic examinations. Am. J. Surg., go: 834-840,
This sigmoidoscopy room is not restricted to proctosigmoidoscopy. During free periods it is used for Auoroscopy, minor surgery, peIvic viewing x-ray fiIms, informa examinations, conferences and storage of treatment carts. SimiIarIy, the medica aid performs duties on the floor or eIsewhere when not assisting at sigmoidoscopy. Senior medica students are encouraged to watch and take part in proctosigmoidoscopic examinations. After instruction and assisting at ten examinations, the average student can safeIy perform an adequate sigmoidoscopy.
1955. 3. GRINNELL, R. S. and LANE, N. Benign and maIignant adenomatous polyps and papiIIary adenomas of the colon and rectum. An analysis of tumors in 1,335 patients. Internat. Abstr. Surg., 106: 5 19-538, 1958. 4. RILEY, C. R. and HAAG, H. B. An enema solution in a disposable unit: experiences with fifty patients requiring enemas. Gastroenterology, 32: 747-749, 1957. 5. Department of Surgery, Ohio State University HospitaI. UnpubIished data. 6. STERN, E. Cytologic screening for cervica1 cancer. Comparative findings in a six year survey of a we11 popuIation. Cancer, I I: 122-126, 1958.
RESULTS
Routine sigmoidoscopy at Ohio State University Hospital has shown that 5.5 per cent of
308
Use of Routine
Sigmoidoscopy
ALAN B. CAMERON, M.D., Columbus, Ohio From tbe Department oj Surgery, Medical Center, Columbus, Obio.
PERSONNEL
Obio State University
A senior medica aid is in charge of the sigmoidoscopy room. Besides maintaining the equipment, she aIso scheduIes examinations, administers enemas, transports patients and assists at sigmoidoscopy. Patients are scheduIed at forty-five minute-intervals. The medica1 aid’s saIary at Ohio State University Hospital is about $ I .50 an hour. The cost of the medica aid’s time per examination then is about $1.12.
ROCTOSIGMOIDOSCOPY combined with digita recta1 examination is the best method of detecting benign and early maIignant Iesions of the rectosigmoid. For this reason the Department of Surgery at Ohio State University Hospital estabIished proctosigmoidoscopy five years ago as part of the routine physica examination offered to surgica1 patients. An outIine of our procedure for routine and indicated proctosigmoidoscopy is presented herein. The cost is low in time and money. Because of this we hope other hospitals wiII be interested in estabIishing simiIar programs. By impressing the house staff and medica students with the ease and vaIue of routine sigmoidoscopy, our program aims to encourage them to use the examination in their future practice. This would greatly reduce the incidence and mortaIity of carcinoma of the rectosigmoid [r-3].
P
PROCEDURE Each patient is scheduIed at Ieast one hour prior to examination. The medica aid administers a disposabIe enema forty-five minutes prior to examination. This is the only preparation required, and it takes about five minutes of the aid’s time. The approximate cost of the enema unit is 33 cents [4]. Thirty minutes after evacuation of the
EQUIPMENT
TABLE I EQUIPMENT
On the surgical floor at Ohio State University HospitaI, a treatment room, IO by 16 feet in size, was converted for proctosigmoidoscopy. The equipment purchased is itemized in TabIe I. Two items on this Iist are expensive. The proctologic tabIe now costs about $600. Its advantage over a Iong tabIe or stretcher cart (cost about $200) is that it aIlows for versatiIity in positioning the patient for sigmoidoscopy and for pelvic examination. The portable suction apparatus costs about $450. Its advantage over Iess expensive table units is that it can be moved easity for suction purposes in other areas when it is not empIoyed in the sigmoidoscopy room. The total cost of the equipment is about $2,000. If this is entireIy written off on the first 10,000 proctosigmoidoscopic examinations, the cost of equipment per examination would be 20 cents.
NEEDED
FOR
Proctologic tabIe Instrument cabinet Dressing carriage Instrument tabIe Suction machine Metal swivet stooI Foot stoo1 3 Large scopes z Medium scopes 2 SmaII scopes 12 Extra batteries 24 Extra buIbs 2 Battery holders 2 Suction tips 2 Biopsy forceps I Anoscope 6 Recta1 specuIums 2 Recta1 probes Long cotton swabs
307
American
Journal
PROCTOSIGMOIDOSCOPY
ROOM
Anesthetic ointment Lubricating jelly Emesis basin Round basin Plastic basin, I I by 14 inches MetaI pan, I I by 14 inches Biopsy specimen bottIes 32 Ounce bottle of H aIcoho1 and J6 ether I GaIIon of Zephiran I GaIIon of SpaI detergent Rectal gloves Draw sheets Hand towels 6 PiIIow cases I Record book I ScheduIing book 12
12
oj Surgery.
Volume
~9. March,
1960
Cameron asymptomatic patients have poIyps. Of these, 15 per cent show histologic evidence of maIignancy. In addition, about one in 200 have a previousIy unsuspected maIignancy in the rectosigmoid [5]. This yieId of definiteIy precancerous and cancerous Iesions is much Iarger than the yieId of such lesions of the cervix discovered by routine cervica1 and vagina1 smears [6J.
enema, the sigmoidoscopy aid brings the patient to the examination room. He is pIaced in the position desired by the sigmoidoscopist at the time scheduIed for the examination. The physician arrives at this time and performs the examination. This usuaIIy requires about ten minutes. He is then free to return to other duties. This feature has been very popuIar with the busy attending and house staff. The medica aid assists the sigmoidoscopist by handIing swabs, instruments and the suction apparatus. After the examination the medica aid returns the patient to his room. She then administers an enema to the next patient, and returns to clean the room and equipment.
SUMMARY
Reduction in the incidence and mortality of carcinoma of the rectosigmoid may be accompIished by widespread use of routine proctosigmoidoscopy. A detaiIed low-cost program is presented for performing such examination on hospita1 patients. By giving house staff and medical students experience with the examination it is hoped they wiI1 use it routineIy in their future practice.
COST
As itemized previousIy, the approximate cost of sigmoidoscopy per patient is $I .65. This is Iess than the cost of a routine blood count in most hospitals.
REFERENCES
COMMENTS I. PORTES, C.
and MAJARARIS, J. D. Proctosigmoidoscopy-incidence of poIyps in 50,000 examinations. J. A. M. A., 163: 411-413, 1957. 2. WILSON, G. S., DALE, E. H. and BRINES, 0. A. Detection of poIyps in 20,847 routine sigmoidoscopic examinations. Am. J. Surg., go: 834-840,
This sigmoidoscopy room is not restricted to proctosigmoidoscopy. During free periods it is used for Auoroscopy, minor surgery, peIvic viewing x-ray fiIms, informa examinations, conferences and storage of treatment carts. SimiIarIy, the medica aid performs duties on the floor or eIsewhere when not assisting at sigmoidoscopy. Senior medica students are encouraged to watch and take part in proctosigmoidoscopic examinations. After instruction and assisting at ten examinations, the average student can safeIy perform an adequate sigmoidoscopy.
1955. 3. GRINNELL, R. S. and LANE, N. Benign and maIignant adenomatous polyps and papiIIary adenomas of the colon and rectum. An analysis of tumors in 1,335 patients. Internat. Abstr. Surg., 106: 5 19-538, 1958. 4. RILEY, C. R. and HAAG, H. B. An enema solution in a disposable unit: experiences with fifty patients requiring enemas. Gastroenterology, 32: 747-749, 1957. 5. Department of Surgery, Ohio State University HospitaI. UnpubIished data. 6. STERN, E. Cytologic screening for cervica1 cancer. Comparative findings in a six year survey of a we11 popuIation. Cancer, I I: 122-126, 1958.
RESULTS
Routine sigmoidoscopy at Ohio State University Hospital has shown that 5.5 per cent of
308