Dr Klara Garsed & Dr Catherine Fraser on behalf of The Digestive Diseases Centre, Royal Derby Hospital for excellence in service delivery in the launch of the CoGS (Complex Gastroenterological Symptoms) clinic in Oct 2016
Authors and Institution
Dr Klara Garsed; Consultant Gastroenterologist
Dr Catherine Fraser; Consultant Gastroenterologist
Dr Caroline Scott, Clinical Psychologist
Dr Joanna Miatt, Clinical Psychologist
Julie Youle, Dietitian
Helen Gibbs Specialist Nurse
Emily Tulk (nee Palmer), Transformation Project Manager
Annabel Shaw Deputy General Manager
In 2016/7 the 8 highest attendance patients within gastroenterology at the Royal Derby Hospital incurred annual costs on average of £12300 (range £2600-34450). Patients with functional abdominal symptoms can remain as inpatients for prolonged periods of time. Staff feel pressurized and somewhat impotent in trying to meet their patients’ psychological and social needs. When surveyed, only 11% of clinicians locally felt patients with persistent physical symptoms were usually satisfied with the explanation and management plan provided. We hypothesized that addressing the psychological needs of people living with complex and persistent functional gastrointestinal symptoms and providing emotional support for their clinical team would reduce hospital attendance and prove cost-effective.
How we managed the challenges
We launched the CoGS (Complex Gastroenterological Symptoms) clinic in October 2016 with the following aims;
- To manage gastroenterology patients with complex functional needs in an outpatient setting, to investigate them in the same way as others with irritable bowel syndrome, and to order further investigations only with a robust formulation and with considerable care;
- To offer patients a holistic formulation of their difficulties, taking into account psychological, social and medical complexities and to build on coping skills.
The clinic comprises of two gastroenterology consultants, two clinical psychologists, specialist dietitian and specialist nurse, transformation project manager and general manager. Patients were engaged via an invitation to opt into the CoGS clinic, with an explanation of its make-up and objectives.
Evaluation and Outcomes
Of the 5 patients analysed so far, there were 22 fewer contacts after CoGS attendance (inpatient, outpatient, emergency department and day case). Follow up ranged between 5 and 7 months. This is a reduction of 4.4 contacts per patient. Overall costs (including drug and investigations) for these patients were £8392 lower, equivalent to £1678 saving per patient. Initial patient feedback has been positive;
“ … asked questions which had never been asked before … came away feeling hopeful and reassured”;
“I am improving every day. Not just my health, my work, social life, relationships and mental state too”;
“… support is invaluable and I feel lucky to have been asked to attend CoGS and have such wonderful care and support”
Individual WHO-QOL-BREF results have shown up to a 23-point increase. Staff reflections can be summarised as a growing confidence in the power of listening and acceptance of incremental gains in symptoms.
We can demonstrate that a novel multidisciplinary approach to patients in gastroenterology is cost effective, leads to increased staff satisfaction and shows improved patient-reported outcomes.
Staff feedback has been overwhelmingly positive – both from clinic staff and from wider colleagues who we shared progress with via an infographic – supplementary figure. This clinic has catalysed discussions of the needs of this patient group across other specialities. In addition, there is a growing hospital-wide interest in improving recognition and management of the psychological impact of illness on patients as well as staff. This pilot has been extended for another year and we have had enquiries from other specialities and assessment units about extending parts of this model.
Contact details for members interested in getting more information
Digestive Diseases Centre,
Royal Derby Hospital,
University Hospitals of Derby and Burton NHS Foundation Trust,