Review for 10.1186/1471-230X-12-12 (2012)

Reviewer's report
Title:"Drop in" gastroscopy outpatient clinic - experience after 9 months
Version: 1Date:3 October 2011
Reviewer: Christopher S Davis
Reviewer's report:
This study by Huppertz-Hauss et al demonstrates a forward and much needed
approach to working around barriers to patient care, for which they should be
commended. The duration period of the study is reasonable and the sample size
is relatively robust. The greatest limitation is presentation and transparency of
data. I would hope to see this and a few other concerns address:
Minor Essential Revisions
1. Surveys were taken from patients, referring physicians, and clinic staff. Rather
than discussing select questions, how many total questions were asked in each
survey, what were they specifically, and what were the results of each question?
Comparing appointment and drop-in patients, were there statistical differences
between groups? Demonstrating these data in one or more tables would likely be
helpful.
2. Table 2 represents the total number of gastroscopies as well as outpatient
gastroscopies. It is unclear the significance of including both non-outpatient and
outpatient gastroscopies, as the two populations may not be comparable in terms
of disease process and acuity. Also, the number of non-outpatient gastroscopies
in each study period was virtually identical (452 vs 450). A more useful
comparison would be to focus on the frequencies of the various diagnoses
between appointment and drop-in patients in 2009, and then only if necessary to
mention if there were differences compared to outpatient gastroscopies in 2008.
These differences should also be expanded upon. For instance, you diagnosed
17 additional outpatient esophageal and gastric cancers in the same study period
in 2009 versus 2008. This is important.
3. In the first part of the results on page 5, time from first medical visit to
gastroscopy was described. Both averages and medians are used. However, it is
customary to choose one or the other (mean ± SD or median with interquartile
range) based on data distribution. This minor point should be addressed.
4. Were there any complications? Were the rates of outpatient complications
similar between both study periods and between appointment/drop-in patients?
5. It is mentioned that 18% of drop-in patients did not like the wait time on the
day of gastroscopy. What was the average wait time? Similarly, the discussion
states that the unpredictability of drop-in frequency improved over time. What is
meant by this, and did the wait time for drop-in patients improve during the
course of the study?
Discretionary Revisions
1. Is the increased volume a function of increased referral to your center from
publicity?
2. The introduction states that females tend to be categorized as “low priority.”
You have found that 59% of drop-in gastroscopies are female, compared to 45%
of those by appointment. Though just shy of statistical significance, this could be
viewed as a potential success of the drop-in concept, and may warrant further
investigation and/or a sentence or two in the discussion.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests