Download to read offline
Uploaded byNHS Improvement
Increasing access or improving mortality in endoscopy – the acute versus elective debate
The document discusses the increasing demand for endoscopy services and addresses challenges related to capacity, patient safety, and mortality rates, particularly during weekends. It highlights operational management improvements, including scheduling, referral guidelines, and the implementation of weekend services to enhance efficiency and patient outcomes. The document concludes with positive results from a pilot program, showing reduced length of stay and timely care for gastrointestinal bleeding cases without increased mortality.
More Related Content
![Cytopathology Of Cerebrospinal Fluid[1]Power Point](https://cdn.slidesharecdn.com/ss_thumbnails/cytopathologyofcerebrospinalfluid1power-point-1230479978520994-2-thumbnail.jpg?width=640&height=640&fit=bounds)
Similar to Increasing access or improving mortality in endoscopy – the acute versus elective debate
![Delivering care in efficient environment medicall 2011 [compatibility mode]](https://cdn.slidesharecdn.com/ss_thumbnails/deliveringcareinefficientenvironment-medicall2011compatibilitymode-110831063224-phpapp02-thumbnail.jpg?width=640&height=640&fit=bounds)
Increasing access or improving mortality in endoscopy – the acute versus elective debate
- 1. Increasing access or improving mortality in endoscopy – the acute versus elective debate Dr Riaz Dor Consultant Gastroenterologist
- 3. Endoscopy Demand Continues toincrease • Aging population • Target procedures • JAG requirements • Surveillance procedures • Colonoscopy > UGI Endoscopy • CRC screening • Future?
- 4. Drivers for change •18 week pathway • Waiting list management • Capacity • Patient satisfaction • OOH GIB
- 5. OOH GIB • Current practice • BSG UGIB Audit (2007) • Pt safety • Mortality higher at weekends • denovo presentations vs IP (mortality almost twice) • Juniors/ Seniors concerns • Ad hoc service at weekend
- 6. Ironing out thecreases - 1 Operational management • Referral guidelines • Vetting • Validation of surveillance • Scheduling • Escalation policy
- 7. Ironing out thecreases - 2 Data collection/ Planning • DNAs • Share information
- 8. Ironing out thecreases - 3 Managing Capacity/demand • Proactive vs reactive • Regular review • Colonoscopy Preassessment • Optimise existing capacity/'dropped lists' • Timings audit
- 9. Ironing out thecreases - 4 Review variation • Procedures Patient engagement • PB vs FB • DNA reduction • Satisfaction
- 10. Drivers for changeNMUH • AMU working • Consultant weekend working • WLI expense • Limited physical space • ‘The right time’
- 11. Options • Optimise currentlists • 8- 9am lists • Evening lists • Weekend lists • More WLI • More rooms • More endoscopists
- 12. WLI • Efficient • Throughput • Popular • Case selection • Demand management • Ad hoc vs continuous • Costly
- 13.
- 14. Benefits • Safer • ImproveM&M • Help capacity – inpatient and outpatient • Commisioners • ‘GIB Distress Syndrome’ • ? LoS
- 15. What did wedo? • Job planned • 5 gastro • 5: 8 weekends • Planned working • Reduction in AMU working • ACU low risk GIB
- 16. Weekend plan 0900 –0915 handover 0915 –1030 6 elective points 1030 –1200 Sat Sun GIB GIB Elective IP Inreach TCI elective IP '
- 17. Examples • PEG tubes •GI bleeds • Enteral Tube feeding • Post procedure problems • ? ERCPs
- 18. Experience • Very positive •Rewarding • Relief from other teams • Sunday in reach service v popular • Not too onerous • Buy in from colleagues • ?others
- 19. Has it madeany difference ? • All GIB bleeders scoped within 24 hours • No overnight calls • LoS reduced by 1.8 days • No excess in mortality • Capacity vs WLI • Monday morning calmer • Happier teams
- 20. Challenges • Nursing Rotas •Porters • Planning of lists • Case selection • Too popular ! • Remaining 3 weekends
- 21. Success Success What it should look like. What it really looks like
- 22.