POSITIVE IMPACT OF NURSE-LED CLINICAL VALIDATION AND STRICT APPLICATION OF GUIDELINES TO ENDOSCOPY WAITING LISTS IN A TERTIARY IRISH HOSPITAL

Aims Assess the impact of nurse-led clinical review and the application of guidelines (European Society of Gastroenterology and National GI Endoscopy Quality Improvement Programme) to endoscopy lists to see if this will result in an increase in capacity within the system.

Methods A retrospective audit of patients currently overdue a surveillance procedure according to old guidelines. Previous endoscopy and histopathology reports were reviewed to evaluate the appropriateness of the procedure. Selected patients were contacted for up-to-date information and preference. From the ESGE and NQIG guidelines, a framework of criteria was developed and applied to postpone, remove, and schedule patients.

Results 1651 patients were overdue endoscopic procedures from the 2014–2018 surveillance lists. Clinical validation of 546 of these endoscopic procedures till now (435 colonoscopies and 111 OGDs) yielded the following results: 82 (15%) colonoscopies and 2 (0.4%) OGDs were postponed and 158 (28.9%) colonoscopies and 43 (7.9%) OGDs were removed. This resulted in a total of 84 (15.4%) procedures rescheduled and 201 (36.8%) procedures removed from waiting lists. The remaining 195 (35.7%) colonoscopies and 66 (12.1%) OGDs, totalling 261 (47.8%) procedures were scheduled to be performed.

An immediate cost saving of €133,260 was gained from the removal of 201 procedures. A further saving of

€29,115 was gained due to 84 procedures, resulting in a total cost saving of € 162,375. Additionally, 285 endoscopy spaces were released.

Conclusions This nurse-led role is a positive process which addresses the capacity gap. Adherence to guidelines allows for a framework that balances clinical need and service demand. The appropriate listing, significant cost savings, and increased endoscopy capacity allow for a more efficient and streamlined service.