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Theevolvingdiagnostic service of endoscopy

One of the many benchmarks by which the NHS – and the public it serves – measures the effectiveness of the service is how long a patient has to wait in a queue. Kate Woodhead RGN DMS asserts that diagnostic services are a key element of this as, at this stage, the patient often doesn’t know if they are unwell or just has a collection of annoying or worrying symptoms.

How long a patient has to wait is variable, depending on the tests they need, the local capacity for those tests and whether those tests are available in their area. The six week diagnostic waiting time was introduced initially as a ‘milestone’ from March 2008 onwards, achieving the standard ‘referral to treatment’ wait of 18 weeks by December 2008. Diagnostic waiting times now form part of the pledges made to patients, cited within the NHS Constitution, that patients should not have to wait longer than six weeks for a diagnosis.1 Diagnostic services underpin 80% of clinical pathways and account for around £8 billion of NHS annual expenditure. With improvements in diagnostics and targeted interventions which will be possible with the development of genomics, personalised medicine and other enhanced treatment schedules for cancers, this is set to increase in volume and complexity going forward.2 Endoscopy services – and bowel screening specifically – have increased the volume of GI tract endoscopies exponentially in the last few years. The age range has recently been expanded. Initially, the programme sends an occult blood testing kit to individuals every two years between 60 to 74 years of age. In recent times, the lower age limit has been moved to 50 years old. Anyone with an abnormal result from this screening is offered a colonoscopy. The workload, therefore, for all endoscopy units has increased immeasurably. Most

endoscopy units were built many years ago, when standards of service, requirements for cleaning, decontamination and high level disinfection and storage were very different. Some endoscopy units have squeezed themselves into ever tighter spaces and others have delegated all the decontamination activity to sterile services in order to increase the clinical space; others have availed themselves of the self contained mobile units. The situation described has led to a number of significant challenges for the service. Enhancing access to seven day

Most endoscopy units were built many years ago, when standards of service were very different, requirements for cleaning, decontamination and high level disinfection and also storage were very different.

MAY 2019

services has also had an impact with a stated standard for diagnostics (including reporting) that they will be available seven days a week within one hour for critically ill patients, 12 hours for urgent patients and 24 hours for non urgent patients. The standard is designated to be achieved by 2020. The demand for a faster sleeker service due to the workload is considerable which includes decontamination and return to service. The achievement of high level disinfection uses many of the same principled steps it used to but there are many new variables. The chief requirement is that the items are clean ie: free of protein and organic matter so that they do not pass on any potential infection to subsequent patients. The chemistries have changed with the move away from ‘aldehydes towards peracetic acid based formulations. After disinfection, standards for water purity have increased so that there is reduced risk of re-introducing bacteria via rinse water and more frequent stringent testing.


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