A STANDARDS-BASED AUDIT LOOKING AT THE APPROPRIATENESS OF COMMUNITY REFERRALS FOR IN-HOSPITAL ELECTIVE OGD

Aims To reduce the number of inappropriate and unnecessary elective OGDs performed. To encourage proper use of the guidelines both in the community and by in-hospital Doctors.

Methods During a 3-month period, 188 patients had been admitted for an elective OGD. Our sample size included 150 of those patients, chosen by random selection. We used the NICE guidelines for OGD referrals from the community (Table 1); looking at patient demographics, patient symptoms, the use of PPIs, the use of H2 receptor antagonists and H Pylori (HP) testing. We also considered the presence of any red flag GI symptoms.

Results Of the 150 Day case OGDs analysed, 84 (67%) had been referred by their GP. The remainder had been scheduled for an OGD from OPD appointments or during a previous in-patient admission. Of the GP referrals, 80% had indicative symptoms as per the NICE guidelines. (Fig1. Demonstrates symptoms and frequencies). Of these, 60% had received treatment with four weeks of PPI, 7% received treatment with four weeks of H2 receptor antagonists and 4% had non-invasive HP testing prior to referral, as recommended by NICE guidelines (attached below).

Conclusions In conclusion, excepting those with red flag symptoms, all patients < 55 yr should have HP testing and an adequate therapeutic trial of PPI prior to referral for OGD. The rationale for this is the very low yield of management altering pathology diagnosed at OGD in such cases set against the risk and costs of endoscopy. Highlighting such guidance to GPs and other referring doctors is therefore of paramount importance to improve the quality, safety and cost effectiveness of health care in this area. We now plan to examine the prevalence of HP in this cohort referred without prior testing.