Lower GI and the 18WW how we do it

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Lower GI and the 18WW - how we do it

• Mike Bradburn

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Northumbria Healthcare

• 500,000 population
• 3 DGH
• 7 cottage hospitals
• Area 75 by 50 miles

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5 Endoscopy Units 8 Rooms Wansbeck 3
Rooms Alnwick 1 Room Berwick 1 Room NTGH 2
Rooms HGH 1 Room
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3
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2
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Endoscopists (n 36) 11 Consultant
Gastroenterologists 7 Upper GI Surgeons 6 Lower
GI Surgeons 10 Nurse Endoscopists 2 GP
Endoscopists
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• Principles
• Endoscopy pooling
• Colorectal referrals

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Principles

• Capacity demand analysis
• Map the process
• Pooling
• Triage
• Straight to test
• Booking

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Capacity demand
http//www.steyn.org.uk/
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Mapping the Process
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Pooling
Doc 1
Investigation
Treatment
Doc 2
Treatment
Investigation
Doc 3
Investigation
Treatment
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PS 70 Female Fe ? Anaemia

• GP Refers Physician 8/1/99
• Medical OPA 7/52 11/3/99
• OGD D2 Bx 3/52 31/3/99
• Medical OPA 2/52 15/4/99
• Colonoscopy 5/52 19/5/99
• CT 6/7 25/5/99
• Refers Surgeon 6/7 25/5/99
• Surgical OPA 10/7 4/6/99
• Right Hemicolectomy 2/52 21/6/99
• 6 months

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OB 76 Female Fe ? Anaemia

• Urgent Ref 9/8/01
• Dx Colonoscopy 30/8/01
• CXR U/S 6/9/01
• MDT 7/9/01
• OPA 7/9/01
• Right Hemicolectomy 11/9/01
• 33 Days

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How we do it endoscopy pooling

• OPD decision
• Paper based triage decision
• Electronic triage
• ICARUS

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Triage

• Paper based
• Doctor
• Nurse
• Choose Book

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Choose Book
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Colorectal CAS
GP referral
Virtual clinic 8 hours per day 5 days per week
Telephone Triage
Choose Book
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History by proforma

• Cade et al 2002 Lancet
• Identification of risk of CRC from PCQ

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Triage and Straight to Test
     
1Not including cancers presenting with other
factors eg anaemia 2Not including cancers with
palpable tumours B Overt rectal bleeding C
Change in bowel habit P Anal symptoms including
soreness, discomfort, itchiness, lumpiness,
prolapse pain A Abdominal pain
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Minimise paper chase

• Electronic
• Verify anaemia
• Verify patient has been given prep
• Verify patient details on PAS

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Win - Win

• GP patient
• Simpler choice choose provider only
• Software triages to urgent allocates 2 week
  appt
• Simple referral - almost dont have to provide
  clinical details
• Patient choice of date, time, location, clinician

• Secondary care
• Single queue for paper CB referrals and IP
  referrals
• Minimises clinical time spent triaging
• Maximises straight to test
• Ready printed history on arrival
• Developing a huge symptom database

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In Summary

• Capacity demand analysis
• Flow analysis
• Pooling
• Triage
• Straight to test
• Booking