VETTING BY GENETIC COUNSELLORS IMPROVES APPROPRIATENESS OF COLONOSCOPY FOR PATIENTS ON SURVEILLANCE REGISTER WITH FAMILY HISTORY OF COLORECTAL CANCER

Aims The demands for endoscopy have increased and robust vetting of patients on the waiting list for colonoscopy could reduce the waiting lists. In our hospital all patients on the surveillance register are vetted by endoscopists for appropriateness based on information available on the previous reports/referrals. For the patients undergoing surveillance because of family history of colorectal cancer, the vetting team may not have information regarding the full family history or access to the family genetic screening results. For this sub group, we organised a one off vetting by the genetic counsellors from our regional genetics team. The aim was to ensure that these patients are on the correct surveillance schedule.

Methods Patients were identified from the endoscopy reporting database. Genetic Counsellors stratified the patients into four groups – screening intervals to remain the same, increase, decreased or discharged. Patients were referred to the clinical genetics for further assessment if there was insufficient family history or family history of high moderate risk.

Results 323 patients were undergoing surveillance because of family history of colorectal cancer. After the assessment 93(28%) of patients were discharged and there was a change in the screening schedule for further 50(15%) patients. There was no change in screening schedule for 73(22%) and 107(33%) patients were referred for further review to genetics team. Even with conservative estimates, this exercise was able to release 18 lists to be utilised for other patients. Cost of overall administrative work equated to £4,000 with a cost saving of £42 K.

Conclusions Robust vetting by genetic counsellors of patients who are on the colonoscopy surveillance register for family history resulted in creating extra capacity by removing any patients who were being inappropriately listed for the test. We plan to roll out this methodology across the regional endoscopy units in Cheshire and Merseyside.