ENDOSCOPY
With demand for gastrointestinal (GI) endoscopy in the UK expected to grow over the next decade due to increased patient expectations, greater emphasis on early diagnosis and better uptake of screening,2 good endoscope design ergonomics will become increasingly important to the quality of inspections and patient comfort. For these reasons innovative manufacturers like Fujifilm are already incorporating these elements into their design. To address demand, GI endoscopic procedures that have traditionally been carried out by doctors are increasingly being performed by nurses and other practitioners – known as clinical endoscopists. Nurse endoscopists already undertake as much of 20% of the workload in an endoscopy unit, and NHS Improving Quality initiatives have estimated that up to 40% of low risk, high volume endoscopic procedures could potentially be carried out by clinical endoscopists.
Training an additional 200 clinical endoscopists
NHS Health Education England launched a training programme to support the Secretary of State’s commitment of an additional 200 clinical endoscopists by 2018. Following a pilot selection process developed with the Joint Advisory Group on GI Endoscopy (JAG), 40 registered health professionals from across England were selected to train in two cohorts starting in January and April 2016. The programme provided a comprehensive blended learning package including completion of the Competence Assessment Portfolio. Having successfully completed the course, trainees from the first cohorts are now able to deliver procedures in either upper-gastrointestinal (GI) endoscopy or flexible sigmoidoscopy, providing expanded workforce capacity, greater skill mix and improved services for patients. The Office for Public Management (OPM) was commissioned to conduct an independent evaluation of the training pilot. The independent report, which looked at the impact and effectiveness of the training, detailed the success of the programme while also offering recommendations to improve, which have been implemented throughout the report development. It found that the
Bowel cancer statistics
41,804 new cases of bowel cancer, 2015, UK 16,384 deaths from bowel cancer, 2016, UK 57% survive bowel cancer for 10 or more years, 2010-11, England and Wales 54% preventable cases of bowel cancer, UK
majority of trainees from the first cohort are helping to meet endoscopy service demands within their own Trusts, freeing up medical colleagues and impacting positively on patient care. The trainees themselves also welcomed the professional and career development opportunity, whilst Trusts valued the accelerated approach.
Ergonomic design
For Dr Hayee good ergonomic design is as crucial as an endocope’s light intensity and modalities. “Fujifilm has really thought about every aspect of design and function, as besides superb light quality the new scopes are easy to handle and use,” Dr Hayee continued. “From its smaller and more responsive grip console, to its graduated stiffness and much slimmer endoscope shaft design, the scope is one of the most effective I’ve used, working perfectly with the natural anatomy of the body. Taken all together, I would say this represents a true advance in endoscope technology.” Such ergonomic advancements can make a significant difference to the quality of inspections, thanks to a quicker and more comfortable insertion, which provides crucial additional time to search for abnormalities during the endoscope withdrawal process.
If we’re to better meet the uptake of endoscopic screening and early diagnosis that public health bodies are demanding, then the necessary training and take up of systems incorporating these new advancements must be a top priority. Dr Bu’Hussain Hayee, King’s College Hospital NHS Foundation Trust.
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WWW.CLINICALSERVICESJOURNAL.COM It’s a benefit Dr Hayee is already noticing:
“Although the overall length of procedures is the same, the system I’m now using gives me extra inspection time, which makes a real difference. Its smart design ergonomics are not only enhancing the quality of my inspections, but helping my patients too, with many of them telling me how much more comfortable they feel with the new scope.” Patient comfort is really important as many patients can be extremely nervous about having an endoscopic procedure for the first time. And considering the hard work bodies such as Public Health England are having to do to encourage more eligible people to come forward for screening, good ergonomic endoscope design is becoming more critical than ever.
Endoscopy equipment manufacturers are now competing to develop the most comfortable designs, carefully considering the features they can incorporate to make the screening process for patients as comfortable as possible. From graduated stiffness and developments in grip console and shaft design, to other ergonomic improvements that are making endoscopes more flexible and easier to handle and steer through the gut and colon. Such innovations can make a real difference to how comfortable patients feel both during and following a screening investigation.
Improvements in gastroenterology
For a gastroenterologist like Dr Hayee specialising in upper and lower GI and catering for a wide range of conditions including Crohn’s disease, ulcerative colitis and bowel cancer screening, such improvements are crucial to his investigation and treatment of patients. And it’s why having benefitted from many of these design modifications together with its use of LED imaging, that Dr Hayee uses the Eluxeo 7000 system.
NOVEMBER 2018
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