endoscopy matters nice guidance dyspepsia, new build, national context & naedi dr michelle...

Endoscopy Matters

NICE guidance dyspepsia, New build, National Context & NAEDI

Dr Michelle GallagherConsultant Gastroenterologist

Current pathways into diagnostics for upper GI symptoms….

GP TWR to clinic or

direct to test

GP referral to OP

C&B direct access

endoscopy

Gastroenterology

Upper GI surgery

Diagnostic Endoscopy

NICE guidance

• Immediate (same day) referral for:– Significant gastrointestinal bleeding

• Urgent referral (within 2 weeks) is indicated at any age for: – Progressive dysphagia – Unintentional weight loss – Epigastric mass – Suspicious barium meal – Iron deficiency anaemia – Persistent vomitin

• Recent onset “unexplained and persistant” dyspepsia alone in those over 55

Local Performance TWR and C&B open access

endoscopy

RSCH Upper GI Cancer Diagnoses 2010/2012

• 377 TWR referrals (18% cancer; national average 14%)

• Of all Upper GI malignancies– 32% referred as TWR– 23% Non TWR referral– 29% Emergency presentation via A&E– 16% Internal referrals

Open access?

PROS?

• Straight to test– Shortened patient

pathway

• No OP consultation

• ? Cost

CONS

• Reduced opportunity to speak to a specailist

• Test only

• Complex patients

• Unrestricted access – Increased activity!

Choose & Book Direct Access Endoscopy RSCH

• C&B direct access OGD established 2008

• 4 C&B slots per week– 1 Gallagher– 1 Preston– 1 Soon– 1 Tibbs

• Audit– 6/12 data analysed

Choose & book audit

• 68% male• Age range 25-75• 100% pre treated with PPI therapy!• All but 3 endoscopies undertaken by

Consultant / SPR under supervision• 5 OPA appointments generated– 3 Non medical endoscopist– 1 Malignancy– 1 Newly diagnosed portal hypertension

Results – Indication within NICE?

Results – Endoscopic diagnosis?

RSCH Endoscopy

• 2 rooms• > 7000 procedures pa• Increased proportion therapeutic

endoscopy– Cancer services– Bowel cancer screening– Non invasive tests• MRCP• (CTC)

New Unit

• Due to open Autumn 2012

– 4 rooms– Compliant with single sex

accommodation & infection control standards

– Dedicated “quiet room”– 1 room for BCSP!

NAEDINational Awareness and Early Diagnosis Initiative

• Cancer Reform strategy 2007– DoH– Cancer Research UK– National Cancer Action Team

• Co-ordinate and provide support– Activities which promote early diagnosis

of cancer– Research

UK Cancer Statistics

• Cancer survival – measure of effectiveness of healthcare

• 10 000 “avoidable deaths” pa UK• Diagnostics surrogate marker for effective

healthcare• 25% new cancer diagnoses following

emergency presentation• 1 year survival poorer for emergent

presentations

NAEDI

“……..Work stream 1 aims to achieve earlier (and more appropriate) presentation of potential cancer patients with symptoms to primary care. It focuses on interaction with members of the public up to the point of presentation”

NAEDI Be clear on cancer campaign

• 2 pilots – SW & East of England• 48% increase in the number of people who

visited their GPs with symptoms • 32% increase in urgent referrals to hospitals • Campaign recognition was high with 75% of

the public saying they had seen the advertising

• Overwhelming support for the campaign – 96% of the public and 89% of GPs believed it

was important.

Be Clear on Cancer

………………..National campaign February 2012!