IRISH SOCIETY OF GASTROENTEROLOGY
Poster Winners 2020 - First Prize
Connolly Hospital and RCSI, Blanchardstown, Dublin 15
Endoscopy nurse triage significantly reduces urgent, non-urgent and surveillance endoscopies with significant inter-rater agreement with consultant gastroenterologists after 1 year
VK Narayanan, E Gibbons, S Lynn-Ryan, CK Shahzad, A Hussain, J Fenn, B Hall, O Kelly, C Smyth, RJ Farrell
Department of Gastroenterology, Connolly Hospital and RCSI, Blanchardstown, Dublin 15
Despite established referral guidelines many patients are referred inappropriately for symptomatic and surveillance endoscopy. Triage of endoscopy referrals is essential to reducing waiting lists. Limited data exists assessing the impact of endoscopy nurse triage and the inter-rater agreement between consultant gastroenterologists and triage nurses.
We prospectively compared the effect of our triage nurse (appointed January 2019) on endoscopy referrals and inter-rater agreement between triage nurse and consultant gastroenterologists.
All endoscopy referrals including health-link between January 2019 and July 2020 were stratified into urgent/(P1), non-urgent/(P2) and surveillance groups prior to nurse triage based on established HIQA/BSG guidelines. Missing referral data including prior endoscopy/histology and alarm symptoms were validated by telephone before being vetted by 4 consultant gastroenterologists. Inter-rater agreement between nurse triage and consultant gastroenterologists were compared for the periods Jan-Mar 2019 and May-July 2020.
Of 2273 patients referred for endoscopy, 1231 patients were urgent/P1, 615 were non-urgent/P2 and 427 were surveillance. Nurse triage reduced urgent referrals by 56% (p<0.001), non-urgent referrals by 27% (p<0.001) and surveillance referrals by 36% (p<0.001) with a large proportion redirected back to GP, OPD, HP testing, FIT, CT colonography or discharged from surveillance lists. Substantial agreement between triage nurse and consultant gastroenterologists in early 2019 (Κ=0.645) increased to almost perfect agreement by mid 2020 (Κ=0.94), P<0.001).
Endoscopy nurse triage can achieve significant reductions and cost savings in P1, P2 and surveillance endoscopy referrals. After 1 year, endoscopy nurse triage using established endoscopy referral guidelines can approximate decision making by experienced gastroenterologists.