ISTCs offer endoscopy best practice
Dr Eva Vincze, Ph D, Consultant Gastroenterologist,
Ramsay Health Care
Endoscopy procedures have become routine, but high
demand initially meant long waiting lists. Part of the solution has
come from independent sector treatment centres (ISTCs), which are
purpose-designed for rapid
access.
Ramsay Health Care, a leading independent healthcare provider,
has 11 ISTCs providing NHS care in England. Gastrointestinal
endoscopy services have been developing steadily since Ramsay’s
first ISTC opened to patients in 2005. Thousands of upper and lower
endoscopies have now been performed in our treatment centres, which
are equipped with new instrumentation and modern decontamination
facilities.
Efficacy in endoscopy means more than performing large numbers
of procedures. Quality and patient safety are our major focus. Our
waiting time is not longer than two weeks from receiving a GP
referral - and can be as short as one to two days because, as small
units, we can manage cases individually. We follow a strict
pre-assessment process, including a thorough medical assessment for
all patients with high risk of complications. We have collected
quality assurance data since inception of the service, and a
recently installed electronic reporting system will ensure access
to accurate figures as required. All our endoscopy centres have
joined the GRS (Global Rating Scale) electronic quality assurance
assessment tool, and achieved high grades on the system. In
recognition of our data, some of our units were asked to
participate in adaptation of this scale for day case endoscopy
practice.
A presentation on colonoscopy data in four Ramsay treatment
centres during a 12 month period was recently accepted by a
regional British and European Gastro Congress. Analysis of 1,072
colonoscopies demonstrated the caecal intubation rate was 94.9% and
the adenoma detection rate 24.5%. Doses of sedation were within the
guidelines of the British Society of Gastroenterology. We also
record patient comfort and satisfaction levels, reaching 100%
satisfaction in all our units.
Currently our endoscopy units are involved in a process of JAG
(Joint Advisory Group) accreditation. Boston NHS Treatment Centre,
in Lincolnshire, was the first of our units to successfully
complete the process. All of Ramsay’s other ISTCs have made
encouraging progress and will hopefully achieve full accreditation
in the near future.
High quality, JAG-accredited training has been undertaken in our
Bodmin and Cobalt (Newcastle) NHS Treatment Centres in the past two
years. Prominent representatives of JAG were involved. These were
excellent occasions for developing our practical skills and
guidelines, and to share ideas on the role of ISTC endoscopy. ISTC
endoscopists have since been given exciting opportunities to
participate in British and international gastrointestinal
congresses.
Reflecting the quality and safety of our practice, we are
receiving a growing amount of positive feedback from GPs, and even
from our local ‘competitor’ hospitals.
The first few years of ISTC practice have provided growing
evidence of the quality and safety profile in day case endoscopy.
In the future, ISTCs may develop as key providers of diagnostic
procedures, giving inpatient facilities more capacity to focus on
emergency cases and therapeutic endoscopy. Having been JAG
accredited, ISTC endoscopists would also welcome the opportunity to
participate in the national bowel cancer screening program.