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

1. Setting up an OOH
emergency endoscopy
servicethe Leicester experience
Peter Wurm
Consultant Gastroenterologist
Leicester Royal Infirmary
Thanks to Rekha Ramiah, SpR Gastroenterology
Leicester Royal Infirmary

2. Leicestershire
1 Million population
900-1000 upper GI bleeds pa

3. 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



4. 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

5. 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]

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

7. 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

8. Robust referral
protocol
Consultant to consultant referral
SPR [medical, ED ST4]

9. 6/12 periods
Aug- Jan
Breakdown of endoscopic procedures for each six months period.
* PEG insertion/ PEG removal.

10. Timing of OOH endoscopic procedures

11. Emergency vs elective procedures
Year
Total
2006/07
GI bleed
Other
indications indications
97
33
2007/08
138
78
216
2008/09
152
74
226
2009/10
104
84
188
2010/11
124
98
222
130

12. Endoscopic intervention

13. Endoscopic diagnoses

14. Immediate outcome post
endoscopy

15. A developing service

Endoscopy 2005- present [acute and non acute casesto 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

16. 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