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PWE-138 The Value of The Straight to Test (STT) Specialist Nurse in Expediting Patients Referred on A Routine Pathway with Red Flag, Lower Gastrointestinal (LGI) Symptoms To A Diagnostic Endoscopy Procedure
  1. L Steward1,
  2. P Andrews1,
  3. E Seward2,
  4. M Machesney3,
  5. A Wong1
  1. 1Endoscopy Unit, Whipps Cross University Hospital, Barts Health
  2. 2Endoscopy Unit, UCLH
  3. 3Surgery, Whipps Cross University Hospital, Barts Health, London, UK

Abstract

Introduction Our Trust has a well-established STT service to reduce the wait until a definitive diagnostic test in patients with LGI symptoms. STT receives routine18 Week Wait (18 WW) referrals through Choose and Book with a patient- controlled 3 week window. GPs, therefore, currently refer non-target patients to the service. Patients referred on the pathway wait an average of 31 days for procedure (range 13–44). However, it was found from triage assessment that some patients needed to be fast-tracked and investigated within 2 weeks due to the onset and severity of their symptoms, particularly patients with symptoms suggestive of inflammatory bowel disease (IBD).

Methods Routine referrals are vetted and prioritised by specialist colorectal nurses using information from the GP referral letter and patient-reported history during telephone assessment. Triage is based on a structured algorithm following 2 Week Wait (2 WW) and National Institute of Clinical Evidence (NICE) guidelines and a symptom questionnaire is completed. A prospective database captures patients’ symptoms, outcomes of triage, procedures and demographic details. Patients with red flag symptoms referred on a routine pathway were expedited and their outcomes documented. Chi Square statistics were applied to test for significance of findings.

Results 569 patients have been triaged since we began formally fast-tracking (August 2014) .Of those patients, 104 (18%) have been expedited following telephone assessment. 57% of those fast-tracked were female and the mean age was 58 years (range 18–88 yrs). 79% underwent colonoscopy, 3% had a flexible sigmoidoscopy, 1% were referred for an ultrasound scan and 17% were directed for an initial clinic review. The mean number of days from triage to test was 5, which is a 96.5% time-saving on the 18 WW pathway. Of all the patients fast-tracked, 65% had pathology, of which 14% had IBD (age range 18–57 yrs with mean of 39 yrs), compared to 45% pathology findings in routine referrals (p-value < 0.01 ), of which 5% had IBD. The chart below shows the findings at endoscopy:

Conclusion These data suggest that there is a benefit to having a comprehensive history taken by a colorectal specialist nurse in determining the patient pathway in a timely way for diagnosis and start of treatment. With 14% of patients expedited found to have new-onset IBD, the result was prompt treatment of symptoms, and potential avoidance of a hospital admission.

Disclosure of Interest None Declared

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