PTU-100 Inpatient endoscopy: a ‘hot site’ experience

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Abstract

Introduction

Access to inpatient endoscopy is important for both patient management and flow within acute NHS Trusts. A daily dedicated weekday inpatient endoscopy list was introduced at Barnet Hospital, Royal Free London NHS Trust, to enhance service provision in line with NICE guidance (CG141, 2016). We report on our initial ‘hot site’ experience.

Method

A single centre retrospective study involving of all consecutive inpatients requiring endoscopy at a large district general hospital (445 beds) serving a population 5 00 000 during a 5 month period (January – May 2016). All patients were identified from the endoscopy procedure log. Additional data including endoscopy type, indication, therapeutic intervention and hospital discharge within 24 hours of endoscopy were collected using electronic patient records and the ‘Unisoft GI Reporting Tool’.

Results

In total 440 inpatient endoscopies were performed; 322 (73%) gastroscopies, 82 (19%) flexible sigmoidoscopies and 36 (8%) colonoscopies. Median age was 76 years [interquartile range (IQR) 55–86], 53% were male. Gastrointestinal bleeds (GIB) accounted for 192/440 (44%) procedures. 40/192 (21%) lower gastrointestinal and 152/192 (79%) upper gastrointestinal bleeds (UGIB). Additional indications included 48/440 (11%) abnormal imaging, 48/440 (11%) dysphagia, 47/440 (11%) iron deficiency anaemia, 40/440 (9%) diarrhoea, 26/440 (6%) percutaneous endoscopic gastrostomy (PEG) tube insertion, 17/440 (4%) abdominal pain, 17/440 (4%) weight loss, 4/440 (1%) volvulus and 1/440 (<1%) for dyspepsia. Sedation was used in 315/440 (72%) cases, median midazolam dose was 2.5 mg [IQR 1–5 mg] and fentanyl 25mcg (IQR 0–50mcg). Median (IQR) procedure time for gastroscopy, flexible sigmoidoscopy and colonoscopy were 20 (IQR 15–25), 15 (IQR 10–20) and 30 (IQR 25–40) min, respectively. Colonoscopy completion rate was 31/36 (86%). Therapeutic intervention occurred in 88/440 (20%). In total 259/440 (59%) procedures were undertaken within 24 hours of request, 110/152 (73%) UGIB and 30/40 (75%) lower GI bleeds. Overall 30 day mortality was 47/440 (11%) and 114/440 (26%) patients were discharged within 24 hours.

Conclusion

Gastrointestinal bleeding is the most common indication for inpatient endoscopy. A dedicated inpatient endoscopy list improves both patient management and flow with >70% GIB scoped within 24 hours and a quarter of all patients discharged within 24 hour. Therapeutic procedures are expected in a fifth of all inpatient endoscopy. Optimal list timing merits further exploration, as does the prospect of extending the service to further improve outcomes.

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