Increasing access or improving mortality in endoscopy – the acute versus elective debate
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Increasing access or improving mortality in endoscopy – the acute versus elective debate Dr Riaz Dor Consultant Gastroenterologist - presentation from seven day services in diagnostics event held on 4 March 2013 #7dayDiagnostics
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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 to increase • 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 the creases - 1 Operational management • Referral guidelines • Vetting • Validation of surveillance • Scheduling • Escalation policy
- 7. Ironing out the creases - 2 Data collection/ Planning • DNAs • Share information
- 8. Ironing out the creases - 3 Managing Capacity/demand • Proactive vs reactive • Regular review • Colonoscopy Preassessment • Optimise existing capacity/'dropped lists' • Timings audit
- 9. Ironing out the creases - 4 Review variation • Procedures Patient engagement • PB vs FB • DNA reduction • Satisfaction
- 10. Drivers for change NMUH • AMU working • Consultant weekend working • WLI expense • Limited physical space • ‘The right time’
- 11. Options • Optimise current lists • 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
- 14. Benefits • Safer • Improve M&M • Help capacity – inpatient and outpatient • Commisioners • ‘GIB Distress Syndrome’ • ? LoS
- 15. What did we do? • 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 made any 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