Introduction With issues of increasing demand for endoscopy procedures, there is a need to validate surveillance referrals. A nurse-led review of surveillance referrals was set up. The aim was to ensure that patients are seen at the right time based on current guidance – right patient, right time, right test.
Methods A protocol was developed which outlined the process for nurses to review referrals for patients on planned surveillance waiting list for colonoscopy. All referrals were reviewed with the hospital notes; relevant information documented on the protocol form which included changes in health; medication etc. Referrals with no change followed the pathway of original planned care. Referrals which did not meet the guidance (coded by nurses as: no/unsure) were reviewed by consultant colorectal surgeons. After consultant review if there were changes to planned care both the patient and their GP’s were informed by letter of the changes.
Results A total of 296 surveillance referrals were reviewed between March – November 2012.Of these referrals were 126 were appropriate 170 were identified as needing changes to planned care. Of the 170 patients where changes were recommended, 115 were removed from the waiting list. 22 patients had a date change and 33 patients had no change to their planned care. Issues found for patients were: age, mental capacity, patient choice consideration, and documentation were: old versions or incomplete/illegible referrals, initial consultation documentation did not always include family history. See diagrams below:
Conclusion Nurses are able to identify changes to planned surveillance colonoscopy referrals. Reducing risk to patients through inappropriate colonoscopy procedures; reducing waiting list and releasing capacity to other patients. This review shows there is a need to have a validation process of surveillance referrals with a cost saving in our case of 115 less colonoscopies equating to 23 lists.
Further changes to processes could enhance patient care further such as nurse reviewers contacting patients by telephone or in appropriate clinics. Improvements in documentation and electronic data bases for surveillance patients which include family history of colorectal cancer to inform decision making.
Disclosure of Interest None Declared
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S Sarkar,U Duffy,N HaslamImproved clinical outcomes and efficacy with a nurse-led colonoscopy surveillance service Frontline Gastroenterology 2012; 3:16–20
NICE clinical guideline 131 (2011) Colorectal cancer: The diagnosis and management of colorectal cancer
BCSP Adenoma Surveillance Guidance Note No 1Version 1 September 2009