Improving access to endoscopy

services – win – win situation.

Irene Dunkley

Nurse Consultant Gastroenterology

The Team

• Irene Dunkley – Nurse Consultant

• Julie Maddocks – Lead Nurse BCSP.

• Janet Jones – Nurse Practitioner - BCS

• Rose Haggett – Admin support BCSP

• GICU

Problem

• 6 month backlog of validation of referrals for surveillance colonoscopy - colorectal 2011.

• Resulting in Global ratings score for Timeliness fell from A to C in 2011 as surveillance patients waiting >13 weeks in some cases.

• Without A score in timelines risk to continued participation as BCSP site.

• Constant challenges to meet waiting list targets:– cancer pathway seen within 2 week of referral.

– all routine patients seen within 6 weeks or referral

– all surveillance procedure done within 6 weeks of due date.

Validation Process

• Three months before surveillance

colonoscopy.

• Referrals sent to consultant to ensure

colonoscopy still needed under current

guidance.

• Problem was this was not being done by

colorectal team – backlog of referrals not

vetted.

What to do?

Idea!

Adapt current practice

• BSCP NP- good knowledge of colorectal cancer and surveillance procedure guidance.

• Lull in their own workload meant they had enough time to take on this task.

• Protocol adapted and approve by GICU. And clinicians.

• Proforma completed by NP with recommendations based on current guidelines.

• ‘Responsible’ clinician to write to patient if any changes in planned care.

Management of Surveillance Patients

• Protocol developed.

• BCSP - CNS’s make recommendations based on current guidelines.

• Recommendation reviewed by responsible clinician – who writes to patient if changes to planned care are made.

• To date 296 sets of notes have been reviewed.

• 18 sets of notes are awaiting consultant validation (not included).

Validation of Surveillance Referrals

March to November 2012: Results

126

43%170

57%

Is the referral appropriate?

Yes - met guidelines

No/unsure open to interpretation

Outcome Following Consultant Review

115

68%

22

13%

33

19%

Removed

Date change/other

No Change

Summary of success To date

• 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.

• Cost saving in our case of 115 less colonoscopies equating to 23 lists = weeks work.

Further changes ?

• nurse reviewers contacting patients by

telephone or in appropriate clinics.

• Improvements in documentation.

• Electronic data bases for surveillance patients

which include family history of colorectal

cancer to inform decision making.

• Roll out to Endoscopy staff as part of pre-

assessment process

Need more bright ideas…got any?

Let’s talk….