This paper focuses on recent experience in setting up an endoscopy unit in a large regional hospital. The mix of endoscopy in three smaller hospitals, draining into the large hospital endoscopy unit, has enabled the authors to comment on practical and achievable steps towards creating best practice endoscopy in the regional setting. The challenges of using what is available from an infrastructural equipment and personnel setting are discussed. In a fast moving field such as endoscopy, new techniques have an important role to play, and some are indeed cost effective and have been shown to improve patient care. Some of the new techniques and technologies are easily applicable to smaller endoscopy units and can be easily integrated into the practice of working endoscopists. Cost effectiveness and patient care should always be the final arbiter of what is essential, as opposed to what is nice to have. Close cooperation between referral and peripheral centers should also guide these decisions. 1. Introduction In Australia, it is probably easier to define what a teaching hospital is than a community hospital. A community hospital can be defined by what it is not, rather than what it is. It is not a tertiary referral center where research, training, and university affiliations are of primary importance. There are however many larger community hospitals in Australia where registrars rotate. Medical and nursing students are to be found even in small hospitals. A tertiary hospital refers more to the scope of hospital referral, so, for instance, a large hospital in Sydney to which several smaller hospitals send their difficult patients could rightly be called a tertiary hospital. There are however many large community hospitals which drain smaller hospitals, and they in turn would send patients that they could not manage to large university hospitals. The authors’ hospital in Nambour, Queensland represents an interesting mix of practice. The endoscopy department conducts outreach endoscopy in 3 peripheral hospitals serving small towns of less than 30 000 people, upto 70？km from the base hospital. The base hospital has 400 beds and is a community hospital. We have very recently extended our endoscopy unit, transforming it from a single theatre complex-based room, into a standalone endoscopy unit, with dedicated endoscopy nursing staff and two large endoscopy suites. Within 5 years a new teaching hospital will be built, and the hospital district will become a tertiary center. These changes have enabled us to ponder on community-based endoscopy service in Australia,
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