Authors and institution
Dr Rachel Edwards, Dr Peter Foulser, Dr Guan Lim and Dr Stuart Gould (Epsom & St Helier University Hospitals)
What were the challenges?
Introduction
The Covid-19 pandemic continues to cause delays nationally in provision of endoscopy services. As recommended by the BSG, a triage of ‘Planned’ and ‘Routine’ endoscopy waiting lists were conducted within a hospital serving a population of 166,257.
This study aimed to see if consultant-led triage resulted in cost savings and/or a reduction in endoscopy workload.
How did you overcome the challenges?
Methods
The ‘Planned’ endoscopy waiting list included patients on a surveillance pathway or awaiting a follow up procedure. The ‘Routine’ endoscopy waiting list referred to all other outpatient endoscopy requests. Patient records were reviewed on iSOFT Clinical Manager 2.0. Patients were telephoned if further information was needed.
Each endoscopy request was assigned to one of four categories; ‘no longer required’, ‘no change to request’, ‘upgrade request to urgent’, and ‘change request to alternative planned interval’. Outcomes were recorded in an Excel spreadsheet. Patients were informed of any important change in management plan.
Procedures that were deemed no longer required were reviewed in more detail to establish the reason for this. Potential savings made as a result of not carrying out procedures that were categorised as ‘no longer required’ were based on the 2018/19 National Tariff for the procedure with biopsies.
What were the outcomes?
Results
A total of 589 patients were on the endoscopy waiting lists; 326 on the ‘Planned’ list, and 263 on the ‘Routine’ list.
| Outcome after consultant triage of endoscopy request | Planned | Routine |
| No longer required | 79 | 78 |
| No change to request | 202 | 159 |
| Upgrade request to urgent | 14 | 9 |
| Change request to alternative planned interval | 31 | 17 |
| Total | 326 | 263 |
Table 1: Numbers of endoscopy requests triaged into each category across planned and routine waiting lists.
157 (27%) of endoscopy requests were categorised as not required. Reasons for this included updated or incorrect adherence to surveillance guidelines (26%), clinical judgement deeming it no longer necessary (62%), or a change in the patient’s clinical status or unclear indication (12%).
Learning points
Conclusions
- 27% of endoscopy waiting list procedures were judged unnecessary.
- Consultant-led triage of endoscopy waiting lists resulted in an estimated cost saving of £67,993 (a 25% cost reduction) and a reduction in endoscopy workload.
- Potential savings nationally from endoscopy waiting list triage are considerable.
- Triage theoretically increased training opportunities by reducing workload.
- Greater awareness of current guidelines could reduce the number of endoscopies scheduled.
Members interested in getting more information can contact Dr Guan Lim at guan.lim@nhs.net
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