Dr Peter Wurm - acute upper GI bleed service UH Leicester

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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

description

Dr Peter Wurm gives an overview of acute upper GI bleed service at University Hospitals in Leicester Setting up an OOH emergency endoscopy service

Transcript of Dr Peter Wurm - acute upper GI bleed service UH Leicester

Page 1: 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

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Leicestershire

1 Million population

900-1000 upper GI bleeds pa

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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

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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

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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]

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Our current service

•All endoscopy in endoscopy suite [LRI, ambulance services] •Team cross-cover and site familiarity •Mobile units for ITU, theatre [kit]

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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

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Robust referral

protocol

Consultant to consultant referral

SPR [medical, ED ST4]

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6/12 periods

Aug- Jan

Breakdown of endoscopic procedures for each six months period.

* PEG insertion/ PEG removal.

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Timing of OOH endoscopic procedures

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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

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Endoscopic intervention

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Endoscopic diagnoses

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Immediate outcome post

endoscopy

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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

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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

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