How practitioner-led colonoscopy surveillance management improves productivity while saving money

Abstract

The British Society for Gastroenterology (BSG) guidelines for post-polypectomy and post-cancer-resection surveillance were changed in October 2020, essentially excluding a large proportion of patients awaiting a surveillance colonoscopy as they now no longer fit the criteria for surveillance. To audit the colonoscopy surveillance waiting list at the Wye Valley Trust to ascertain patient appropriateness for colonoscopy under the new BSG guidelines. A practitioner-led colonoscopy surveillance clinic led by a clinical endoscopist was set up to audit the colonoscopy surveillance waiting list of over 1200 patients. The aim was to clinically assess each patient against the guidelines and determine discharge from, or continuation of, the surveillance pathway for each patient. The patients were then offered outpatient clinic appointments where fitness was assessed and appropriate investigations were finalised. Patient numbers on the colonoscopy surveillance waiting list were reduced by nearly 50%, with waiting times down to 0 weeks, by facilitating practitioner-led pre-assessment and outpatient clinics, all while saving Weston General Hospital almost £300000 in the initial 9 months. The new colonoscopy surveillance guidelines presented an opportunity to audit and evaluate the colonoscopy guidelines in the Wye Valley Trust. The facilitation of a clinical endoscopist committed time to implement new pre-assessment processes and outpatient clinics, this process allowed the discharge of almost 50% of patients upon the colonoscopy surveillance waiting list, it created extra colonoscopy capacity for 2 week wait and urgent colonoscopies, while generating a positive financial implication for the trust.