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OSE_1309_part2_Layout 1 9/6/13 12:23 PM Page 96 G A S T R O E N T E R O L O G Y a second room so you can have the next patient ready and waiting in the third room. Physicians at South Carolina Medical Endoscopy Center are encouraged to take their time with every patient to ensure they don't miss any adenomas. That means at least 6 minutes, and more optimally 8 minutes, to examine the colon. The longer it takes, the better the examination and the more polyps are discovered. "We measure ADR (adenoma detection rates) quarterly for all 25 physicians and we counsel those that are below 30 [percent]," says Stephen Lloyd, MD, PhD, medical director at the Columbia, S.C., center, and a passionate advocate of using ADR as a measure of a thorough colonoscopy. Recommended guidelines say ADR for each physician should be at least 25% in men and 15% in women. At Endoscopy Center of Ocean County and Toms River, cecal withdrawal times are recorded for peer review of physicians, says Ms. Southern. 8. Let the tech advance the scope. Several facilities let their GI techs or nurses assist with scope manipulation. The technician "drives," keeping a hand on the belly, while the physician "steers," says Ms. Diem. "It takes 3 to 6 months to train a technician to be adept at this. When it works well, when the physician and tech are in sync, it gives the physician more time to concentrate on the screen and on what's in the colon." Says Dr. Lloyd, "We have proven that having a technician advance the scope improves efficiency and quality and reduces complications." 9. Clean at bedside. Preclean at the point of use. Yes, good reprocessing starts in the procedure room. Immediately flush and wipe your scopes post procedure in the room to prevent drying. Wipe the scope of body fluid and debris, and rinse with soapy water in the room as soon as the doctor hands the scope back to the scrub. "You cannot high-level dis9 6 O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2013