1. Phone triage could remove a large proportion of young non-urgent endoscopy referrals from Irish endoscopy waiting lists
B.Christopher, K.Altamimi, C.Egan, C.Garry, R.Lavelle, C.Molloy, O.Kelly, C.Smyth, RJ. Farrell.
Department of Gastroenterology, Connolly Hospital and RCSI, Blanchardstown.
Background / Aim
Results
144 waiters aged ≤ 45
36 (25%) referred after review in GI OPD
108 (75%) direct access referrals from GP
The Irish public endoscopy service is facing unprecedented pressure in terms of a huge increase in endoscopy referrals over the past 10 years with currently over 4,300 people waiting more than 3 months for a colonoscopy.
Despite established referral guidelines almost one-third of patients on Irish endoscopy waiting lists are aged 45 yrs or younger,1 many referred from primary-care on the basis of self-limiting symptoms, with high non-attendance rates by the time their direct access endoscopy appointments are scheduled and whose endoscopies are frequently normal while older patients face delayed diagnosis of their GI cancer.
Our aim was to assess what impact contacting all non-urgent endoscopy referrals aged 45 years or younger by telephone would have on reducing endoscopy waiting lists.
As of March 1st 2016, 144 of the 448 patients (32%) on our priority 2 non-urgent endoscopy waiting list were aged 45 years or younger.
Using a simple pro-forma questionaire five NCHDs attempted to contact all 144 patients by phone to assess whether they still warranted endoscopy.
Patients who could not be contacted or failed to contact a call-back number were removed from endoscopy list and posted a gastroenterology clinic appointment.
46 of the 64 patients (72%) who could not be contacted by phone or whose symptoms had resolved were direct access referrals.
100 young waiters
44 had endoscopy performed / scheduled
50 patients successfully contacted
(no scheduled endoscopy)
50 uncontactable (at least 3 phone contact attempts at different occasions)
14 patients (14%) confirmed happy to cancel endoscopy due to symptom resolution / response to PPI/triple therapy/dietary advice
Conclusion
Simple phone triage could remove almost two-thirds of young non-urgent endoscopy referrals from our endoscopy waiting lists including 14% of patients whose symptoms had resolved while waiting for their endoscopy and 50% of patients who were uncontactable by phone and were consequently rerouted from direct access endoscopy to gastroenterology clinics.
Given their high rate of non-attendance, poor contactibility by phone and high symptom resolution rates, young patients should be preferentially triaged to gastroenterology clinics rather than direct access referral to non-urgent endoscopy lists freeing up much sought after endoscopy slots for older patients who are more likely to attend and more likely to have significant endoscopic findings.
Methods
Reference
1. Health Technology Assessment of Scheduled Procedures: Referral thresholds for patients with upper and lower gastrointestinal symptoms suspected of indicating malignancy. HIQA. July 2014.