ACCESS: A Central Coast Endoscopy Service Solution
15 April 2016 Last updated:
28 April 2016
ACCESS: A Central Coast Endoscopy Service Solution
This project developed a standardised, direct referral pathway for public colonoscopy services from the general practitioner (GP).
View a poster from the Centre for Healthcare Redesign graduation, April 2016.
To reduce colonoscopy wait times for positive faecal occult blood tests (+FOBT) in high-risk or symptomatic (Category A) patients by 20% and reduce complaints related to colonoscopy services by 20%, by April 2016.
- Simplifies the patient journey.
- Provides centralised management of +FOBT waiting lists.
- Provides an even distribution of workload across sites.
- Improves early detection of bowel cancer, which improves health outcomes and reduces associated costs to the healthcare system.
- Reduces the risks associated with colonoscopies, due to consistent triaging and screening of patients.
- Enhances collaboration between services, to reduce waiting times for individual procedures.
CCLHD have higher than average rates and mortality of bowel cancer and wait 20-25% longer than benchmark timeframes for a colonoscopy, which is the diagnostic tool for bowel cancer detection. The waiting time to see a colorectal specialist is often up to 3-4 months, which can contribute to delays in diagnoses and treatment.
Inequities also exist between patients who see a visiting medical officer and those who see a publically-funded staff specialist. There are also inconsistencies in the use of clinical priority categories for determining urgency, which has resulted in patients with less urgency been prior to those whose cases are more urgent. Differences also exist between clinicians, with gastroenterologists and general surgeons seeing patients in inconsistent timeframes. An audit of general surgeons showed a wait time of 45% over benchmark timeframes for Category B patients waiting for a colonoscopy.
It was determined that a standardised, direct referral pathway for public colonoscopy services from the GP would improve colonoscopy waiting times and improve the patient experience in CCLHD.
- A solutions workshop with the project team and steering committee members was held, using validated solution design techniques.
- A modified referral and triage form from HealthPathways NZ was developed for use across CCLHD, to provide consistency in the triaging process.
- The referral and triage form is designed to be sent directly to a clinical nurse coordinator (CNC), who triages the patient and provides access to colonoscopy services within benchmark timeframes.
- Patient stories and satisfaction surveys will be used to assess the patient’s experience.
- A screening tool was developed for CNCs, to determine appropriateness and urgency of booking.
- A web-based registration form was developed, to integrate with the CCLHD electronic medical record system. This provides a date stamp at every stage of the patient journey, to assess where delays are occurring.
- Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.
- April 2015 – April 2016
- Gosford Hospital, CCLHD
- Wyong Hospital, CCLHD
- Hunter New England Local Health District
- Central Coast Primary Health Network
- Electronic medical record registration forms will record date stamps to measure:
- GP referral to registration
- registration to CNC assessment
- CNC assessment to colonoscopy booking
- colonoscopy booking to procedure
- CNC assessment to specialist referral (if not suitable for direct access)
- specialist referral to date of specialist appointment (if not suitable for direct access).
- Other evaluation measures will include:
- patient stories and satisfaction surveys
- GP satisfaction and ease of use (with assistance of HealthPathways team)
- number of referrals via new model of care
- review of Accident and Incident Management System (AIMS) reports and complaints relating to CCLHD colonoscopy services.
A robust communication plan is extremely important. Despite regular communication between the project team, executive sponsor and steering committee, there was no centralised communication process. This led to some miscommunication and resistance to achieving the aims of the project. To rectify this, we scheduled a 90-minute meeting with steering committee members, to address the miscommunication between stakeholder groups. It was able to be rectified, but not until six months into the project.
If the team was to repeat the process, we would place a greater emphasis on transparency in communication with all stakeholders, allowing access to minutes of all meetings and a regular enewsletter that communicated the progress of the project.
- Ahmed J, Mehmood S, Khan SA et al. Direct access colonoscopy in primary care: is it a safe and practical approach? Scottish Medical Journal 2013; 58(3): 168-172.
- Vega-Villaamil P, Salve-Bouzo M, Cubiella J et al. Evaluation of the implementation of Galician Health Service indications and priority levels for colonoscopy in symptomatic patients: prospective, cross-sectional study. Revista Espanola De Enfermedades Digestivas 2013; 105(10): 600-608.
- Maruthachalam K, Stoker E, Chaudhri S et al. Evolution of the two-week rule pathway – direct access colonoscopy vs outpatient appointments: one year’s experience and patient satisfaction survey. Colorectal Disease 2005; 7: 480-485.
- Segarajasingam D, Pawlik J, Forbes G. Informed consent in direct access colonoscopy. Journal of Gastroenterology and Hepatology 2007; 22: 2081-2085.
- Hunter New England Local Health District. Rapid Access Colonoscopy: Faecal Occult Blood Test. Agency for Clinical Innovation; 2015.
- National Bowel Cancer Screening Program
- HealthPathways (Restricted to Central Coast health professionals.)
- National Health and Medical Research Council. Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer. NHMRC ; 2005.
Cancer Systems Innovation Manager
Central Coast Local Health District
Phone: 02 4320 9804
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