Straight To Test (STT) Lower GI Endoscopy (from July 2018) Chesterfield Royal Hospital Currently You send pts for colonoscopy We ask them the same questions in clinic And…. Send them for colonoscopy (usually) Best practice Is implemented inconsistently across the country

STT Why Saves time Earlier diagnosis/reassurance Saves health economy money (costs the hospital) Manage the increase in referrals Benefit clinic capacity for non 2ww Embed accessibility to endoscopy at primary care level Be able to flex capacity to demand to some extent

STT Disadvantages Loss of income for CRHFT Investment required  Ensuring all Primary Care Referrals are on a CCG approved template  Ensuring adequate capacity at correct time

STT Process 2ww proforma Admin triage at CRH Significant PMH, Drug History, Functional Status Incomplete – ?can we safely assess- to clinic? Admin triage at CRH >80-, WHO 2+, Abdo mass, anal mass -to clinic Everyone else – to Nurse vetting/assessment (consultant support)

STT Process Flexi or Colon Assessed Check bloods/meds/high risk issues Phone consult if needed Prescribe bowel prep. Community dispensed vs CRH dispensed Information sent If cannot safely assess- 2ww clinic.

STT endoscopy results We will deal with results at consultant level We will organise ongoing Ix as necessary from the assessment Issues ?Haemorrhoidal treatment IBD diagnoses Severe benign colorectal disease (DD) Functional Other system Dx – Gynae/urol etc

In the future Refinement of process Ongoing monitoring Audit Feedback from yourselves/pts National Standard now – a must do for all FIT CTVC