Introduction Endoscopy services within the UK are under pressure with increasing demand predicted and a need to maintain timeliness. The Department of Health for England and Wales wishes to improve outcomes for colorectal cancer and so increase the volume of lower GI endoscopy. Endoscopy services must increase efficiency to meet this challenge. We felt there was an opportunity to increase quality and reduce variation by ensuring all scheduled colonoscopies complied with National and departmental guidance. This is a key quality standard of the Global Rating Scale. We identified sessions in job plans of 3 nurse endoscopists within our trust. We then identified the guidance, informed endoscopists and the management team of the exercise we were undertaking and finally evaluated the intervention to be shared within our directorate team.
Methods Patients awaiting scheduled colonoscopy were identified form the Primary Targetted List database held by the trust to manage waiting and scheduled patients. Patients being followed up for colorectal cancer were excluded from the process and study as there was no single protocol being followed at the time of the study. The patient groups studied were therefore those on surveillance pathways for polyp follow up, family history or inflammatory bowel disease.
Clinical teams within the trust were informed by the clinical director of the process and that BSG guidelines for the conditions listed above were to be followed. The initial phase of the process was undertaken by a single Nurse Endoscopist. Following validation against guidelines, the case was reviewed by the clinical director and a letter addressed to the patient and copied to the patient’s GP and secondary care consultant. The letter was co-signed by the nurse and the clinical director.
Following the establishment of the process as feasible, two other nurse endoscopists were trained in validating the procedures. Sessions were identified in job plans to ensure this process could be perpetuated long term.
Large numbers of surveillance colonoscopies are undertaken (73–124 per month). Many were listed on basis of colonoscopy findings and not checked for histology. A wide range of clinicians including non-endoscopists were listing patients. Guidelines were not adhered too. There was resistance to this standardisation from clinicians, GPs and patients initially.
Conclusion Wide variations in practise were observed. A large number of unnecessary colonoscopies were deferred to a more appropriate interval, producing benefits in quality and efficiency using existing resources.
Disclosure of Interest None Declared.
BSG (2010) Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups BSG (2002) Surveillance following Adenoma Removal