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Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
Dr David Parker - acute upper GI bleed services SW England
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Dr David Parker - acute upper GI bleed services SW England

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Dr David Parker gives an overview of the acute upper GI bleed services in South West England

Dr David Parker gives an overview of the acute upper GI bleed services in South West England

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  • 1. AUGIB services: The South West Perspective David Parker Gastroenterologist BSG Regional Representative for South West England
  • 2. Geography  Gloucestershire, Wiltshire, Bristol, Somerset, Devon, Cornwall  The M4/M5/A30 corridor  A361, A303, A353
  • 3. Severn Deanery Trusts  Swindon  Gloucestershire  Cheltenham  Gloucester  North Bristol  Southmead  Frenchay     University Hospitals Bristol (BRI) Weston-super-Mare Taunton Yeovil
  • 4. Peninsula Deanery Trusts  North Devon (Barnstaple)  Exeter  Torbay (Torquay)  Plymouth (Derriford)  Royal Cornwall (Treliske, Truro)
  • 5. Some Golden Standards of Care  Underpinned by NICE, SIGN, BSG     24/7 rota staffed by suitably skilled people If not available in-house, a formal network Suitably qualified/experienced nurses on call All forms of therapy available 24/7  Banding, dual (triple?) therapy, glue  All high risk patients endoscoped within 24h  All unstable patients endoscoped within 2 h of adequate resuscitation  (All acute GI bleeds endoscoped within 24h)
  • 6. A problem: definitions  NCEPOD audit confusion  “GI bleeding” codes  Lower GI bleeds are included in data searches  How do you define “acute UGI bleed”?  High risk bleeds or all bleeds?  Therapeutic cases only?  Coffee ground vomits?  Scoring systems  Out of hours workload or all cases?  When does OOH start?
  • 7. A problem: measuring workload  Non-responders  Out of hours workload or all cases?  When does OOH start?  Daily bleed lists/slots
  • 8. What we know  6 trusts have 24/7 rota staffed by Gastroenterologists  1 has regular Sat AM list  3 trusts 24/7 rota shared with Surgeons  1 trust has regular Sunday AM list  1 trust 24/7 rota shared between gastro and surgery but gaps  Reliant upon goodwill?  2 trusts have ad hoc arrangements shared with Surgery  both 5/7, but one has timetabled Sunday AM bleed list  Planning formal 24/7 rotas  Reliant upon goodwill?
  • 9. Comments  Various solutions  Large trusts OK (heavy workload; 500 pa)  1 “network”  Various problems  Still some gaps in 24/7 cover  Surgeons still need to help  Level of therapeutic experience?  Isolated trusts  Small trusts
  • 10. Three Case studies  Split site  Example of networking  Small trust  Needs to network?  Isolated trust  50+ miles / 1 hour 15 minutes from nearest neighbour
  • 11. Case 1: split site (1)  One trust  2 DGH hospitals: 600k population  Both take acute unselected admissions  One rota covers both sites  Bleeds done on both sites  Rota 24/7: Gastroenterologists  Weekday bleed lists 0800/1230  100 out of hours bleeds pa  In-pat and new pat scoped <24h
  • 12. Case study 1: Split site (2)  Problems:  Access to theatres  Sometimes have to wait for a gap between surgical/orthopaedic cases  No instances of having to be in two places at once (yet)  Lack of familiarity with unit/kit not an issue  Hospitals 8 miles/20 minutes apart
  • 13. Case study 2: Small trust (1)  Population 180k  1 site  Rota 1 in 8 (3 gastro, 5 surgeons)  2 AM slots daily Mon-Fri for in-patients  OOH cases usually done in theatre  Endoscopy Nurse on call  ~140 cases pa but most scoped in hours  All high risk cases scoped <24h  ~45 therapeutic interventions pa.
  • 14. Case study 2: small trust (2)  Problems:  None of the surgeons want to do it  Some of the surgeons do low numbers of diagnostic OGD  Not all on the rota can/willing to band/glue  Other physicians do 1 in 11. No extra pay for the gastroenterologists.  Some rota gaps: dependent on goodwill (Gaps are paid for)  Once in past year management had to ask neighbouring trust to cover  Prospect of networking not popular  Significant workload if have to participate in cover at larger trust  Risk of in-comers lack of familiarity with kit/unit
  • 15. Case study 3: Isolated trust (1)  1 site  160k population  1 in 8 rota  3 gastro, 5 surgeons  Other physicians do 1 in 11  Gastro gets extra 0.125 PA extra  Endoscopy nurse on call
  • 16. Case study 3: Isolated trust (1)  Potential Problems:  Isolation  50 miles from nearest neighbour  A roads  1 hour 15 minutes in winter; longer in summer months  Network not practical  No issues yet  Rota in infancy
  • 17. Summary & conclusions (1)  10 trusts have a formal rota  Large trusts Gastroenterology  Small trusts shared with surgery  Others working towards rotas  Surgeons seem disinclined to participate  Skill set not always complete  Low numbers of routine OGDs  Networks challenging  Distance  Potential “two places at once”  Participation in onerous rotas not popular
  • 18. Summary & conclusions (2)  Where do we go from here:  Support training of consultants on rotas  JAG accredited courses are costly  Limited Study leave  Press for Gastroenterology to come off medical take?  Unlikely in smaller trusts  Other ideas?

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