Dr Peter Wurm - acute upper GI bleed service UH Leicester
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Transcript of Dr Peter Wurm - acute upper GI bleed service UH Leicester
Setting up an OOH
emergency endoscopy
service-
the Leicester experience
Peter Wurm
Consultant Gastroenterologist
Leicester Royal Infirmary
Thanks to Rekha Ramiah, SpR Gastroenterology
Leicester Royal Infirmary
Leicestershire
1 Million population
900-1000 upper GI bleeds pa
UHL NHS Trust
LRI- acute site with large ED
GGH- cardio-respiratory unit large ITU, ECMO
LGH- planned care site, surgery
All sites with 2 bedded endoscopy suite
History of OOH bleeder service
Until 2006- ad hoc arrangement [surgeon on call]
Difficult data capture [laparotomy]- one OOH bleeder per week
Issues around management of variceal bleeders, SUI, coroner
Our current service
7 days a week, WE and BH 9am -1 pm with full team
available until 8 pm
2 nurses, decontaminator, porters, consultant, 2 nurses and consultant over night
15 band 6/7 nurses over night. 4.5% supplement, 1% for WE business hours [paid for call outs and late hours], late start in case of late call
10/11 Consultant gastroenterologists: 2 PAs initially now 1
[no GIM]
Bid for extra nurses when bidding for BCS [Bowelscope]
Our current service
•All endoscopy in endoscopy suite [LRI, ambulance services] •Team cross-cover and site familiarity •Mobile units for ITU, theatre [kit]
Access to OOH service?
Business hours- normal referral pathways for emergencies
GI bleed indications Other indications
Haematemesis Dysphagia
Haematemesis + melaena Nausea + vomiting
Melaena Weight loss
Liver disease + evidence of bleed
Diarrhoea
Liver disease + drop in Haemoglobin
Anaemia
Dysphagia + haematemesis
Dyspepsia and previous peptic ulcer
Rectal bleeding IBD assessment
Bloody diarrhoea
Robust referral
protocol
Consultant to consultant referral
SPR [medical, ED ST4]
6/12 periods
Aug- Jan
Breakdown of endoscopic procedures for each six months period.
* PEG insertion/ PEG removal.
Timing of OOH endoscopic procedures
Emergency vs elective procedures
Year GI bleed
indications Other indications
Total
2006/07 97 33 130
2007/08 138 78 216
2008/09 152 74 226
2009/10 104 84 188
2010/11 124 98 222
Endoscopic intervention
Endoscopic diagnoses
Immediate outcome post
endoscopy
A developing service
Endoscopy 2005- present [acute and non acute cases- to aid discharge]
More IP lists to prevent WE overspill
Liver HDU [since 2008], acutely unwell pts [54 beds]
In-reach since August 2013 [increasing base ward cons. presence]
? 2014/15 Consultant rounds WE morning
Hot tips
Endoscopists on call need the support of endoscopy nurses
Ensure the majority of procedures are undertaken in endoscopy
Endoscopists will need to take a step back from acute medical on-call commitments
Regularly educate and inform medical and surgical colleagues
It is useful to set a required level of seniority to access endoscopy consultant expertise
Timely referral of bleeders
Keep data
Sue Cottle, NHS Improving Quality, NHS, England