‘DIRECT ACCESS’ ENDOSCOPY – CAN WE REDUCE OUTPATIENT BURDEN EVEN FURTHER?

Aims ‘Direct access’ endoscopy (DAE) allows patients to be triaged straight to gastroscopy or colonoscopy prior to seeing a specialist in order to facilitate an efficient diagnosis and treatment plan. Concerns remain about DAE contributing to an increase in routine clinic review that follows procedures, and thus adding strain to an already over-burdened outpatient service. We aimed to review the outcomes of patients undergoing DAE, specifically to assess the proportion resulting in avoidable outpatient appointments.

Methods Retrospective review using a Decision Report Tool query of all DAE patients at Lakes DHB, which serves a population of around 116,000, between April 2020 and March 2021. DAE outcomes were extracted from reports and reviewed by a single author who categorised the main ‘recommendation’.

Results 383 DAE patients (Median age 59 (IQR 44 – 71), 219 Female (57.2%) included. Distribution of procedures: 258 Gastroscopy (67.4%), 75 Flexi Sig/Colonoscopy (19.6%), 50 Bi-directional endoscopy (13.1%).

7.0% of all patients undergoing DAE had a single outpatient appointment (25 in-person and 2 telephone) before being discharged to the community.

Fig. 1

Conclusions One in five patients undergoing DAE return to clinic after the procedure indicating effectiveness of the initial triaging pathway and post-endoscopy management plans. A third of patients that have follow up are only seen once. Face to face follow ups could be reduced further to 1 in 8 patients by introducing a ‘one stop shop’ review at time of endoscopy and considering remote virtual consultation as an alternative.

Publication History

Article published online:
14 April 2022