dr peter wurm - acute upper gi bleed service uh leicester
DESCRIPTION
Dr Peter Wurm gives an overview of acute upper GI bleed service at University Hospitals in Leicester Setting up an OOH emergency endoscopy serviceTRANSCRIPT
Setting up an OOH
emergency endoscopy
service-
the Leicester experience
Peter Wurm
Consultant Gastroenterologist
Leicester Royal Infirmary
Thanks to Rekha Ramiah, SpR Gastroenterology
Leicester Royal Infirmary
Leicestershire
1 Million population
900-1000 upper GI bleeds pa
UHL NHS Trust
LRI- acute site with large ED
GGH- cardio-respiratory unit large ITU, ECMO
LGH- planned care site, surgery
All sites with 2 bedded endoscopy suite
History of OOH bleeder service
Until 2006- ad hoc arrangement [surgeon on call]
Difficult data capture [laparotomy]- one OOH bleeder per week
Issues around management of variceal bleeders, SUI, coroner
Our current service
7 days a week, WE and BH 9am -1 pm with full team
available until 8 pm
2 nurses, decontaminator, porters, consultant, 2 nurses and consultant over night
15 band 6/7 nurses over night. 4.5% supplement, 1% for WE business hours [paid for call outs and late hours], late start in case of late call
10/11 Consultant gastroenterologists: 2 PAs initially now 1
[no GIM]
Bid for extra nurses when bidding for BCS [Bowelscope]
Our current service
•All endoscopy in endoscopy suite [LRI, ambulance services] •Team cross-cover and site familiarity •Mobile units for ITU, theatre [kit]
Access to OOH service?
Business hours- normal referral pathways for emergencies
GI bleed indications Other indications
Haematemesis Dysphagia
Haematemesis + melaena Nausea + vomiting
Melaena Weight loss
Liver disease + evidence of bleed
Diarrhoea
Liver disease + drop in Haemoglobin
Anaemia
Dysphagia + haematemesis
Dyspepsia and previous peptic ulcer
Rectal bleeding IBD assessment
Bloody diarrhoea
Robust referral
protocol
Consultant to consultant referral
SPR [medical, ED ST4]
6/12 periods
Aug- Jan
Breakdown of endoscopic procedures for each six months period.
* PEG insertion/ PEG removal.
Timing of OOH endoscopic procedures
Emergency vs elective procedures
Year GI bleed
indications Other indications
Total
2006/07 97 33 130
2007/08 138 78 216
2008/09 152 74 226
2009/10 104 84 188
2010/11 124 98 222
Endoscopic intervention
Endoscopic diagnoses
Immediate outcome post
endoscopy
A developing service
Endoscopy 2005- present [acute and non acute cases- to aid discharge]
More IP lists to prevent WE overspill
Liver HDU [since 2008], acutely unwell pts [54 beds]
In-reach since August 2013 [increasing base ward cons. presence]
? 2014/15 Consultant rounds WE morning
Hot tips
Endoscopists on call need the support of endoscopy nurses
Ensure the majority of procedures are undertaken in endoscopy
Endoscopists will need to take a step back from acute medical on-call commitments
Regularly educate and inform medical and surgical colleagues
It is useful to set a required level of seniority to access endoscopy consultant expertise
Timely referral of bleeders
Keep data
Sue Cottle, NHS Improving Quality, NHS, England