LTHT Endoscopy Pre-Assessment Complex Patient Service

Congratulations to Shannon Berry (Senior Sister, Endoscopy Pre -Assessment) and Rebecca Ullah (Matron- Endoscopy Services) from Leeds Teaching Hospital Trust, who were the winners of the 2022 Nursing Award for Service Development.

Read their full submission and watch their presentation recording below.

We have created a complex patient pathway for patients requiring endoscopy procedures at Leeds Teaching Hospital Trust. This work has had a significant impact on providing equal access to endoscopy for patients with complex needs such as learning disabilities, mental health disorders, sensory impairments and drug and alcohol dependency. The service uses a person-centred approach and works with multiple agencies to create support for patients prepping for procedures, attending procedures and during endoscopy. This innovative work is still developing and has been recognised during our recent JAG inspection as a positive and unique service across the UK. We would like the opportunity to share this service development with colleagues across the country and enable others to learn and consider similar models of working across other trusts.

How this has made a positive difference for our patients

We have created patient pathways for people with learning disabilities, mental health disorders, drug and alcohol dependencies and sensory impairments. We provide support at best interest meetings and throughout the pre-procedure process as well as on the day of the procedure where necessary. This service has resulted in fewer cancellations due to poor prep and consent issues, reduced DNA and problems with adherence to diabetic or coagulation advice.

We have provided education to both nursing, admin and clinical staff on performing mental capacity assessments and following the correct consent process, communication techniques to use with non-verbal patients or require distraction techniques, recognising and responding to distress reactions and managing behaviours that may pose a risk to self and others and completing associated risk assessments and DOLs were required to improve safety for staff and patients. This training and information sharing has improved the patient experience as they are supported and report a positive patient experience.

Increasing numbers of patients with learning disabilities and mental health disorders are successfully attending for endoscopy and having a positive patient experience, resulting in completion of their endoscopy at the first attempt and 'getting it right first time'.  Individual admission plans are specially designed and added to medical notes when a patient needs TCI and liaising with the patient flow team regarding bed placement enables continuity of care for patients who need support pre or post-procedure on the wards.

Objectives and Scopes

  • To ensure that all patients have equal opportunity to access endoscopy services, regardless of their individual complex needs, to reduce failed procedures and cancellations, and to provide a positive patient experience.
  • Assist with any consent and capacity issues and participate in Mental capacity assessments and best interest meetings to ensure the correct consent process is followed.
  • Provide complex patient screening and pre-assessment to identify any reasonable adjustments that need to be made to improve patient journey and experience.
  • Provide prompt calls for people who need them to take prep and fast, and attend swab appointments.

We work with community care providers to make post-sedation care arrangements or appropriate  TCI decisions. We hold a weekly MDT meeting working collaboratively with the learning disability and mental health team, and addiction management teams to provide holistic care. We have face-to-face pre-assessment with patients who need support in planning and preparation for endoscopy.

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