Introduction University Hospitals of Leicester (UHL) NHS Trust has been offering a comprehensive out of hour (OOH) endoscopy service for almost 10 years. In the wake of rising demands on in-patient endoscopy services we introduced a Consultant led and Gastro-intestinal registrar supported weekday in-reach service in July 2013, with a morning visit to the acute receiving medical units and a daily in-patient emergency list. Our study looked at the effect of this on OOH endoscopy volume, call outs and therapeutic interventions.
Method To compare our data with our previous data set we analysed 6 month periods of OOH data from August to January of each year [2011–15]. Activity was collated by reviewing endoscopy reports [Unisoft reporting tool), separate OOH record books and daily spreadsheet activity returns. We looked at indication and timing of procedures, endoscopic findings, interventions and outcomes.
Results 640 procedures were performed during the study period. The introduction of an in-reach service initially resulted in reduced daytime weekend activity but one-year later weekend activity was back to baseline. Although there was an apparent increase in ‘true OOH calls’, i.e. 5 pm until 9 am over our 5 year period the absolute numbers remain small and are in fact not different from our previous study, with approximately one emergency procedure per week. There was a 15.9% rise in appropriate referrals as per UHL criteria. Endoscopic findings of varices and variceal bleeding increased by approximately 3.5-fold. There was also a 3.5-fold increase in the proportion of endoscopies employing combination therapy and the use of injection mono-therapy halved, a reflection of recent NICE guidance.1The number of patients requiring emergency laparotomy or arterial embolisation remained very small [2–4 cases per 6 month interval].
Conclusion The total number of procedures has reduced compared to 2006–2010.2This is likely to be the result of better education, change in referral pathways and working patterns. The increase of patients presenting with variceal bleeding reflects a nationwide trend. We observed a decrease in the use of adrenaline mon-otherapy and concurrent increase in combination therapy for non-variceal upper gastrointestinal bleeds. Gastroenterology units need to review and re-invent their in-patient and OOH work pattern on a regular basis to address the increasing demands on inpatient endoscopy services.
Disclosure of interest None Declared.
Acute upper gastrointestinal bleeding:management. NICE Guidance (CG141) June 2012
Ramiah R, Wurm P. Provision of an out-of-hours emergency endoscopy service: the Leicester experience. Frontline Gastroenterol. 2013;4:288–295