O45 How nurse led colonoscopy surveillance management improves productivity whilst saving money

Introduction

On recommencement of surveillance after the first wave of the Covid-19 pandemic, the BSG guidelines for colonoscopy surveillance had been updated in October 2020. This created an opportunity to reassess all 1243 colonoscopy surveillance patients by developing a new surveillance nurse led pathway at Wye Valley NHS Trust Hereford (WVT).

Methods

A new Band 7 Non-medical Endoscopist was appointed on transition from Bowel Scope to BCSP and set up a new assessment process to review surveillance patients against the new BSG criteria. Patients who no longer met the new guidelines were written to explaining the change in the BSG criteria. Patients still meeting the surveillance criteria were invited to a nurse led clinic where suitability for colonoscopy was assessed, specific instructions regarding bowel preparation given, renal function assessed and arrangements made for anticoagulation ± diabetic control. Clinics were either face to face or via telephone according to the patient’s wishes.

Results

1243 patients on the initial colonoscopy surveillance waiting list underwent initial validation and 39% of patients were discharged as they no longer met the surveillance criteria. A further 8% were discharged for other reasons (moved away, new health concerns). After clinic assessment, only 34% of the original surveillance cohort were suitable for surveillance colonoscopy, 3% were not fit enough for any surveillance, 2% declined any colonic investigations, 2% agreed to CTC, 2% DNAd, 1% had moved away and 4% were Covid anxious and requested a delay in surveillance. 5% were upgraded to C2WW due to new symptoms. With a combination of reducing demand and increasing capacity back to pre-Covid levels, surveillance waiting times have reduced from 12 months to 6 weeks. The discharges have released 151 colonoscopy lists (758 colonoscopies) to the C2WW and screening programmes. Using NHS tariff for colonoscopy of £372, these 758 discharges achieved a financial benefit of £281,976. The surveillance clinic cost has been 2 Band 7 nursing clinics per week over an 8 month period annualised to £8960 pa.

Conclusions

Nurse led clinics can thoroughly assess colonoscopy surveillance patients against the new BSG guidelines. This substantially reduces demand, reduces waiting times and generates a cost benefit. Quality is also enhanced by specific information of the procedure and anticoagulation issues. This has reduced surveillance waiting times down to JAG recommendations within 8 months. Our new surveillance process has released a total of 151 colonoscopy lists by demonstrating only 34% of the initial cohort of patients remained suitable for colonoscopy surveillance.