| Sumario: | Significance & Background: Flexible sigmoidoscopy is a vital tool in the diagnosis, staging, and surveillance of rectal cancer. It provides key insights into tumor size, location, orientation, and circumferential involvement. It also plays a crucial role in restaging after neoadjuvant therapy and in ongoing surveillance following both operative and nonoperative management. Historically, our institution performed these procedures in the operating room (OR), leading to delays due to limited OR access and the need for pre-procedure surgical consultations. Purpose: This project aimed to evaluate scope options to ensure safety, efficiency, and cost-effectiveness as well as to reduce the time between scheduling and procedure completion for oncology patients. Goals included minimizing delays, improving access to timely care, and identifying a sustainable outpatient solution. Interventions: An interdisciplinary team developed a comprehensive plan to transition flexible sigmoidoscopies to the outpatient setting. This included workflow mapping, staffing adjustments, supply management, and EMR integration. Reusable scopes were ruled out due to sterilization demands, infection control concerns, and infrastructure costs. Disposable scopes were selected for their simplicity, reduced infection risk, and ease of use. A standard operating procedure (SOP) was created, and scheduling templates were optimized to support outpatient implementation. Results: Cost analysis revealed that reusable scopes would require $460,000 in renovations, equipment, and software upgrades. In contrast, disposable scopes required no additional infrastructure, costing $155,000--a 67% reduction in capital expenses while maintaining procedural quality. Data from 93 oncology patients showed an average 17.4-day lag between scheduling and procedure under the OR model. In the first three months of outpatient implementation, 10 procedures were completed. By combining consultation and procedure into a single visit, the average wait time dropped to 10 days, accelerating treatment planning and maintaining surveillance schedules without OR dependency. Discussion: This initiative demonstrates that outpatient flexible sigmoidoscopy using disposable scopes is a safe, efficient, and cost-effective alternative to OR-based procedures. Future steps include expanding outpatient capacity, tracking patient outcomes, and assessing long-term sustainability across oncology services.
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