Endoscopy Services Improving, But Long Delays Still Experienced In Some Parts Of The Country, England
The report also highlights concerns about the quality of care for patients undergoing an endoscopy, a procedure used to detect conditions such as bowel cancer and stomach ulcers.
"Taking a Closer Look" is the second of three reports from the Healthcare Commission, which together present a comprehensive assessment of diagnostic services in England during the period 2005/06. The review looks at the performance of all 201 gastrointestinal endoscopy units in NHS acute hospitals.
Just over a million patients in England undergo an endoscopy each year. An endoscopy is an invasive procedure that uses a probe to check for abnormalities such as ulcers and cancers in the stomach or intestines and remove samples for analysis. Types of endoscopies include: gastroscopies (which examine the upper digestive tract), and colonoscopies and flexi-sigmoidoscopies (both of which examine the lower bowel).
The report says there are wide variations in waiting times. At the time of the review, some patients were waiting more than a year for a routine colonoscopy and some less than a month for the same procedure.
At the end of last year, in the south east, 50% of patients had been waiting for more than 26 weeks for a colonoscopy, while in north east less than 0.2% of patients had been waiting this long.
The Department of Health has stipulated that from this month, all diagnostic tests should be done within 13 weeks of referral. This is to help trusts meet the 18-week referral to treatment target by the end of 2008. In December, 31% of people on a waiting list for a colonoscopy and 20% of those waiting for a gastroscopy had been waiting for more than 13 weeks.
The report also states that 16% of people waiting for a colonoscopy and 9% of people waiting for a gastroscopy had been waiting more than 26 weeks.
The report predicts that about 30 trusts will fail significantly to meet this month's 13 week target for colonoscopies, and that one in five patients will still be waiting over 13 weeks.
The report says that more could be done to reduce waits by:
-- reducing cancellations. One in eight units cancels over 20% of their scheduled endoscopy sessions which is wasteful of staff time and other resources. Reasons for cancellations include competing demands on clinicians' time
-- providing more recovery places where necessary. Some endoscopy units have four times as many recovery beds or reclining chairs for every endoscopy room than others. Thirty-seven percent of endoscopy unit managers said that lack of sufficient recovery space was a major bottleneck
-- making greater use of nurse endoscopists, for example to carry out gastroscopies that examine the stomach
The report also states that the quality of patient care needs to be improved in some units, for example by ensuring that patients are not over-sedated and that they consent to the procedure before they undress.
On quality of care, trusts need to:
-- not over-sedate patients. Guideline doses for sedation of older patients were exceeded in 50% of units
-- ensure patients sign consent forms before they enter the procedure room and undress. This was not done at 44% of units
-- replace outdated equipment. Some endoscopy units are still using endoscopes that are over 11 years old. These are less versatile and less reliable than modern equipment
-- ensure more colonoscopies succeed in examining the target area of the bowel. A worrying 45% of trusts did not even monitor this. Of those that did, in only 41% of trusts were endoscopists able to guide the scope to the target area of the bowel at least 90% of the time, the agreed target for the National Bowel Cancer Screening Programme
-- ensure all endoscopy units have facilities for private discussions with patients if it is necessary to break bad news
-- ensure sufficient toilets are provided
Anna Walker, Chief Executive of the Healthcare Commission, said:
"Most endoscopy units are to be congratulated on the progress that they have made in reducing waiting times and on the quality of care that they provide. However, it is unacceptable that patients in some parts of the country have to wait so much longer than in other regions.
"It is also unacceptable that so many endoscopy units are not monitoring whether procedures have successfully viewed the target area.
"Clearly patients don't want to go through an uncomfortable examination only to find that it has not been a success. Trusts need to be monitoring success rates for endoscopy, and, where necessary, take steps to improve performance.
"The results of this review have been reported back to individual trusts so that where there is a problem, they can address it."
The Healthcare Commission report also notes that referrals for endoscopies are increasing. However, it questions why there are such marked regional differences in the number of endoscopic examinations undertaken per head of population. The number of rectal examinations carried out in the north east was more than double that in London. These variations cannot be explained simply by regional differences in the incidence of cancers. Possible explanations include that patients are referred for more tests in the north east because there is more capacity and shorter waiting times.
The mix of procedures also differs. In the south east 69% of bowel examinations are full colonoscopies rather than the simpler flexi-sigmoidoscopies, compared with only 48% in the northwest. These variations are greater than could be explained by regional differences in the incidence of cancers.
The Commission recommends that there should be clear responsibilities for managing endoscopy services in each trust so that they are adequately represented on forums that make decisions on the allocation of resources for upgrading facilities and equipment. At present, responsibilities for operational development of endoscopy within a trust are often spread among a number of managers. Also, one in seven endoscopy units has no designated consultant in overall clinical charge.
http://www.healthcarecommission.org.uk
Îmbunãtãþirea serviciilor de Endoscopie, dar încã mult timp de întârzieri cu experienþã în unele pãrþi ale þãrii, Anglia - Endoscopy Services Improving, But Long Delays Still Experienced In Some Parts Of The Country, England - articole medicale engleza - startsanatate