1. 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

2. 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

3. 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

4. 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)

5. 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.

6. 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

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