Dr Peter Wurm - acute upper GI bleed service UH Leicester

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Dr Peter Wurm gives an overview of acute upper GI bleed service at University Hospitals in Leicester
Setting up an OOH emergency endoscopy service

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Dr Peter Wurm - acute upper GI bleed service UH Leicester

  1. 1. Setting up an OOH emergency endoscopy servicethe Leicester experience Peter Wurm Consultant Gastroenterologist Leicester Royal Infirmary Thanks to Rekha Ramiah, SpR Gastroenterology Leicester Royal Infirmary
  2. 2. Leicestershire 1 Million population 900-1000 upper GI bleeds pa
  3. 3. UHL NHS Trust  LRI- acute site with large ED GGH- cardio-respiratory unit large ITU, ECMO LGH- planned care site, surgery  All sites with 2 bedded endoscopy suite  
  4. 4. History of OOH bleeder service    Until 2006- ad hoc arrangement [surgeon on call] Difficult data capture [laparotomy]one OOH bleeder per week Issues around management of variceal bleeders, SUI, coroner
  5. 5. Our current service  7 days a week, WE and BH 9am -1 pm with full team available until 8 pm  2 nurses, decontaminator, porters, consultant, 2 nurses and consultant over night  15 band 6/7 nurses over night. 4.5% supplement, 1% for WE business hours [paid for call outs and late hours], late start in case of late call  10/11 Consultant gastroenterologists: 2 PAs initially now 1 [no GIM]  Bid for extra nurses when bidding for BCS [Bowelscope]
  6. 6. Our current service •All endoscopy in endoscopy suite [LRI, ambulance services] •Team cross-cover and site familiarity •Mobile units for ITU, theatre [kit]
  7. 7. Access to OOH service? Business hours- normal referral pathways for emergencies GI bleed indications Other indications Haematemesis Dysphagia Haematemesis + melaena Nausea + vomiting Melaena Weight loss Liver disease + evidence of bleed Diarrhoea Liver disease + drop in Haemoglobin Anaemia Dysphagia + haematemesis Dyspepsia and previous peptic ulcer Rectal bleeding IBD assessment Bloody diarrhoea
  8. 8. Robust referral protocol Consultant to consultant referral SPR [medical, ED ST4]
  9. 9. 6/12 periods Aug- Jan Breakdown of endoscopic procedures for each six months period. * PEG insertion/ PEG removal.
  10. 10. Timing of OOH endoscopic procedures
  11. 11. Emergency vs elective procedures Year Total 2006/07 GI bleed Other indications indications 97 33 2007/08 138 78 216 2008/09 152 74 226 2009/10 104 84 188 2010/11 124 98 222 130
  12. 12. Endoscopic intervention
  13. 13. Endoscopic diagnoses
  14. 14. Immediate outcome post endoscopy
  15. 15. A developing service  Endoscopy 2005- present [acute and non acute casesto aid discharge]  More IP lists to prevent WE overspill  Liver HDU [since 2008], acutely unwell pts [54 beds]  In-reach since August 2013 [increasing base ward cons. presence]  ? 2014/15 Consultant rounds WE morning
  16. 16. Hot tips  Endoscopists on call need the support of endoscopy nurses  Ensure the majority of procedures are undertaken in endoscopy  Endoscopists will need to take a step back from acute medical on-call commitments  Regularly educate and inform medical and surgical colleagues  It is useful to set a required level of seniority to access endoscopy consultant expertise  Timely referral of bleeders  Keep data Sue Cottle, NHS Improving Quality, NHS, England

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