Improving Adherence to Endoscopy Guidelines for Triage and Surveillance In a Single Endoscopy Unit

Aims Encouraging adherence to agreed triage guidelines is a critical facet of endoscopy waiting list management, particularly in the current climate of COVID-19. Unfortunately, few such guidelines exist and there is considerable variability in their application.

The aim of this study was to determine if the use of locally developed flowsheets, created using existing guidelines, could aid in standardisation of endoscopy triage and surveillance in a single endoscopy unit.

Methods Existing international (BSG) and national (NICE, NCSS​​​​ and HIQA) guidelines were reviewed. Simple flowsheets were devised to address upper and lower GI endoscopy triage, polyp and Barretts surveillance, family history of colorectal cancer. A baseline quiz involving clinical scenarios was devised and endoscopy users were invited to participate. The quiz was then retaken after reviewing the relevant flowsheets.

Results 20 endoscopy users took part. The mean number of correct answers increased significantly after reviewing flowsheets (45±11 % v 71±12 %; p=<0.0001). Similar improvements were noted across both the triage and surveillance sections (25±15 % v 25±18 %; p=0.8368), and between nursing and medical staff (24±18 % v 27±15 %; p=0.7075). Consultants had more correct answers than nurses at initial assessment (56±5 % v 42±12 %; p=0.054) but there was no significant difference after reviewing the flowsheets (71±10 % v 66±14 %; p=0.5566).

Table 1 - GI Consultants vs Nursing Staff

	Baseline Quiz	Second Quiz	Improvement
GI Consultants	56 %	71 %	15 %
Nursing Staff	42 %	66 %	24 %
P-Value	0.054	0.5566	0.4018

Conclusions We have shown a significant improvement in triage accuracy after reviewing appropriate guideline flowsheets among medical and nursing staff. While medical staff performed better at initial assessment, there was no significant difference between medical and nursing staff scores after reviewing the guidelines.

We conclude that all staff should refer to guidelines when triaging clinical requests. In addition it reassures us that nurses, with appropriate guidelines as reference, can be utilised to support or replace doctor-led triage.

Citation: Cudmore J, Stewart S, Kerr H et al. eP196 IMPROVING ADHERENCE TO ENDOSCOPY GUIDELINES FOR TRIAGE AND SURVEILLANCE IN A SINGLE ENDOSCOPY UNIT. Endoscopy 2021; 53: S161.

Publication History

Article published online:
19 March 2021