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OC-056 Straight To Test Colonoscopy – A Viable Means Of Shortening Time To A Definitive Diagnosis
  1. P Andrews1,
  2. H Watson2,
  3. M Mistry3,
  4. M Machesney4,
  5. E Seward1
  1. 1Endoscopy, Whipps Cross University Hospital, London, UK
  2. 2Endoscopy, St Thomas’, London, UK
  3. 3NHS Waltham Forest CCG, London, UK
  4. 4Colorectal Surgery, Barts Health NHS Trust, London, UK

Abstract

Introduction Endoscopy units face an increasing demand on their ability to meet timeliness targets. One way of managing demand is to work differently – and straight to test (STT) offers this. Patients with lower gastrointestinal (LGI) symptoms are telephone triaged by a trained specialist nurse direct to the appropriate endoscopic investigation, rather than attending clinic first. Clear benefits to the patient are a reduction in time to wait until definitive (endoscopic) diagnosis, to the Trust in freeing up out-patient staff to work elsewhere, and finally to the local health economy in terms of reduction in clinic costs

Methods We followed a protocol outlined previously by the Dorset group.1 Briefly, a specialist nurse assessed patients by phone and completed a symptom questionnaire. Patients were triaged according to symptoms and age; flexible sigmoidoscopy (<40 yrs, anorectal symptoms only) or clinic (>80 yrs and comorbidity, or major co-morbidity) or colonoscopy (everyone else). Appointments occured within 2 weeks for 2WW patients, or within 6 weeks for 18WW patients. The endoscopist was allowed to arrange further clinic review as was seen fit. A prospective database allowed capture of patient outcomes and demographic details, an estimate of financial benefit was made on the basis of standard charges for surgical (£172) or medical (£220) out-patient clinics.

Results 89 patients passed through the pathway in the first three months, 64% female. Mean age 61 (range 32–88) yrs, 76% were on the 2WW pathway. Only 2% of the patients were triaged to flexible sigmoidoscopy, no patients required clinic assessment first. Mean wait on pathway for 2WW 12.4 days (range 4–20), and for 18WW 28.8 days (range 15–42), all breaches by patient choice. This represented a reduction from the normal pathway of 48% (2WW) and 67% (18WW). DNA rate was low at 1% (unit average 7%). Most common diagnoses were polyps (20%), diverticular disease (20%), IBD (9%). 1 patient had colorectal cancer – a further patient was diagnosed with pancreatic cancer on CT pneumocolon following a failed colonoscopy. 13% patients required clinic follow up. An estimated saving of £14156 was made from out-patient clinic slots that were no longer necessary, with cancellation of over seven new out-patient lists.

Conclusion These data suggest that the introduction of a novel pathway for patients with LGI symptoms can produce significant benefits to the patient in terms of time to definitive endoscopic diagnosis. A financial benefit is also clear, as is the opportunity to redeploy clinic doctors elsewhere.

Reference Wright HL. Colorectal Dis 2012;14:10

Disclosure of Interest None Declared.

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