Sanchoy Sarkar1,2, Una Duffy1, Neil Haslam1. 1. Department of Gastroenterology and Hepatology, Royal Liverpool University Hospital, Liverpool, UK. 2. Royal Liverpool University Hospital and University of Liverpool, UK.
Abstract
BACKGROUND: A nurse practitioner-led colonoscopy surveillance service was introduced to improve appropriateness, validation and compliance with the National Patient Safety Agency safety alert and British Society of Gastroenterology consensus guidance for bowel cleansing agents. OBJECTIVE: To determine the clinical outcomes and efficacy of this new service. DESIGN AND PATIENTS: A 4-month prospective audit of patients due to attend for surveillance colonoscopy. SETTING: Royal Liverpool University Hospital. INTERVENTION: A new nurse practitioner-led surveillance service reviewed all patients before listing. OUTCOMES: Clinical outcomes, service efficiency and cost effectiveness. RESULTS: 224 Patients (median age 68 years, 52% male, and median American Society of Anesthesiologists (ASA) 2) were assessed and 34% had medical factors influencing their colonoscopy. 37% patients were discharged without a colonoscopy, 17% deferred (median >2 years), 6% had died while on the register and the remaining (40%) had their procedure at the agreed interval. The 30-day and 6-month all-cause mortality was 0% for those fit for colonoscopy, compared with 5% and 14%, respectively, for those deemed unfit. The did-not-attend (DNA) rate was reduced from 7.6% to <1%. With 95 patients not requiring a colonoscopy a potential £40 000 saving to the primary care trust was made. CONCLUSIONS: The nurse practitioner-led surveillance service has been invaluable for guideline adherence and medical management of patients before colonoscopy. In addition, it potentially avoided procedural all-cause mortality in these patients. It has proved to be efficacious with reduced DNA rates and over one-third of patients assessed did not require a colonoscopy.
BACKGROUND: A nurse practitioner-led colonoscopy surveillance service was introduced to improve appropriateness, validation and compliance with the National Patient Safety Agency safety alert and British Society of Gastroenterology consensus guidance for bowel cleansing agents. OBJECTIVE: To determine the clinical outcomes and efficacy of this new service. DESIGN AND PATIENTS: A 4-month prospective audit of patients due to attend for surveillance colonoscopy. SETTING: Royal Liverpool University Hospital. INTERVENTION: A new nurse practitioner-led surveillance service reviewed all patients before listing. OUTCOMES: Clinical outcomes, service efficiency and cost effectiveness. RESULTS: 224 Patients (median age 68 years, 52% male, and median American Society of Anesthesiologists (ASA) 2) were assessed and 34% had medical factors influencing their colonoscopy. 37% patients were discharged without a colonoscopy, 17% deferred (median >2 years), 6% had died while on the register and the remaining (40%) had their procedure at the agreed interval. The 30-day and 6-month all-cause mortality was 0% for those fit for colonoscopy, compared with 5% and 14%, respectively, for those deemed unfit. The did-not-attend (DNA) rate was reduced from 7.6% to <1%. With 95 patients not requiring a colonoscopy a potential £40 000 saving to the primary care trust was made. CONCLUSIONS: The nurse practitioner-led surveillance service has been invaluable for guideline adherence and medical management of patients before colonoscopy. In addition, it potentially avoided procedural all-cause mortality in these patients. It has proved to be efficacious with reduced DNA rates and over one-third of patients assessed did not require a colonoscopy.
Authors: Stuart R Cairns; John H Scholefield; Robert J Steele; Malcolm G Dunlop; Huw J W Thomas; Gareth D Evans; Jayne A Eaden; Matthew D Rutter; Wendy P Atkin; Brian P Saunders; Anneke Lucassen; Paul Jenkins; Peter D Fairclough; Christopher R J Woodhouse Journal: Gut Date: 2010-05 Impact factor: 23.059