Working together to deliver endoscopy services
Why change was needed
The need to respond to the Covid-19 Pandemic meant that many services had to be paused during the first wave of the pandemic. Although staff worked hard to restore services, the pandemic has resulted in increased waiting lists of patients needing care, as well as reduced capacity to deliver services, as we adhere to new infection control measures to keep both staff and patients safe.
An endoscopy is a procedure where organs inside the body are looked at using an instrument called an endoscope. This is used to investigate unusual symptoms and identify their cause. Endoscopy screening services, including those for bowel cancer, were amongst those which were paused. The number of available appointments for endoscopies was also reduced.
As the pressure on the hospitals from the first wave receded, in addition to restarting the bowel cancer screening programme and treating those patients who had already been referred for an endoscopy, we also observed a rise in overall demand for endoscopy services. This was potentially because patients are now more comfortable visiting their GP following the rollout of the Covid-19 vaccination programme. This demand further increased the pressure on endoscopy services across the system.
In November 2020 the list had grown to almost 3,000 patients across all pathways waiting over 6 weeks. This increase in waiting times created a risk of potential serious harm for patients as the earlier bowel cancer is identified, the higher the patient’s survival rate.
What we did
We knew collaborative partnership working would be pivotal to the success of restoring endoscopy services across Coventry and Warwickshire. A recovery group was assembled consisting of clinical and operational representatives from University Hospitals Coventry & Warwickshire, George Eliot Hospital and South Warwickshire Foundation Trust to review the situation and to plan our response.
Historically, there has been no previous cross-provider working in endoscopy and these new relationships were forged from across the various hospitals in a relatively short period of time. A mutual aid agreement was agreed to formalised the process of supporting different organisations to work more closely together. This agreement meant that hospitals could actively support each other with demand issues.
Due to social distancing restrictions, a “virtual room” was created to bring key people together to meet as a team and discuss issues and solutions. This virtual room also provided a space for escalating issues to senior staff as required.
Available appointments were identified across all endoscopy units, so if one unit was pressured, patients could be offered the alternative of going to another unit and being seen more quickly. Private hospitals provided additional support, further increasing our overall ability to deliver procedures.
In order to ensure that the collaborative working was efficient, standard operating procedures were put into place. These procedures allowed patients and consultants from other trusts to move around the system safely, which helped patients to be seen more quickly and consultants to familiarise themselves with the different settings.
Alternative clinical procedures were also identified, such as Computed Tomography (CT) colonoscopy, also known as a virtual colonoscopy. This will help reduce the waiting lists for pressured pathways by offering a quicker alternative for suitable patients.
Through working in partnership to make the best use of all our appointments and exploring new ways of working we were able to support patients to access endoscopy services more quickly, improving their chance of benefiting from early intervention. By March 2021 there were just 176 patients waiting over 6 weeks, a reduction of over 90%, delivered in just over 4 months.
The learnings from the project have been used to draft a long-term plan to maintain our success and to inform future projects.
New initiatives are in development to support longer term sustainability. These include delivering virtual colonoscopy, nasal endoscopy, FIT and new endoscopy rooms.