PTH-063 Is Evening Endoscopy Cost Effective?

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Abstract

Introduction

Currently in the UK we are seeing an increasing demand for endoscopy services that is set to continue to rise over the coming years.1 Our aim as an endoscopy department is to deliver a patient focused service, and patient choice is an integral component of this. The option of evening endoscopy lists is a novel approach to widening patient choice for provided services whilst simultaneously working towards a 7 day working week. Our aim was to evaluate the success of evening lists in terms of attendance and endoscopic outcomes to ensure the most cost effective evening service whilst identifying potential areas for development.

Methods

We analysed data for scheduled evening endoscopy sessions (18.00 to 21.00) booked at Gloucestershire Royal Hospital over a 3 month period from April 2013. Information about pre-endoscopy fast, endoscopic results and non-attendance (DNA) rates was processed.

Results

54 patients were listed for endoscopy, of these 18 (33%) endoscopies were inconclusive; 6 (35%) abandoned due to food bolus, with 9 (53%) non-attenders. Food bolus patients had fasting times between 6–8 h (as per protocol), but all had taken a substantial meal pre-fasting and 50% were diabetic. All non-attenders were booked for variceal surveillance.

Conclusion

Developing evening services is essential to meet user needs; however more guidance is needed to ensure cost effectiveness for the trust. In order to run the most efficient service we need a more specific target audience, excluding certain patient groups (variceal surveillance and diabetics) and prioritising others (2 week waits). Variceal surveillance patients had high DNA rates and would be more appropriate on a daytime list where a DNA can be replaced by an inpatient. Diabetics would benefit from morning lists, both for easier glycaemic control and to reduce food bolus (with a longer overnight fast). Improved patient fasting information is essential with specific guidance for pre-fasting meals, with focus on reducing ‘heavy’ foods, particularly rice based meals. Further work is needed to identify other areas for improvement and refine the service, and ultimately produce a protocol for evening endoscopy that is generalisable to UK endoscopy departments.

Disclosure of Interest

None Declared.

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