Recovering endoscopy services during the COVID-19 pandemic

Overview

To respond to the COVID-19 pandemic, Coventry and Warwickshire STP needed to pause its bowel cancer screening programme and significantly reduce capacity across the system. This presented a particular challenge to endoscopy services in Coventry and Warwickshire and resulted in long waiting times for patients. By November 2020 the list of patients waiting for over six weeks had grown to almost 3,000 patients across all pathways.

Through working in partnership across the three acute trusts, new ways of working together were developed which meant the STP was able to restore its endoscopy services effectively. This approach, which ensured that all available capacity across every endoscopy unit was used and alternative pathways identified, meant that by March 2021 there were just 176 patients waiting over six weeks, a reduction of over 90 per cent.

The challenge and the context

The need to respond to the pandemic meant that many services had to be paused during the first wave. Although staff worked hard to restore services, the pandemic resulted in increased waiting lists of patients needing care, as well as reduced capacity to deliver services, due to adherence with new infection control measures to keep both staff and patients safe.

Alongside restarting the bowel cancer screening programme and treating those patients who had already been referred, the STP also observed a rise in demand for endoscopy services, potentially because patients were now more comfortable visiting their GP following the rollout of the vaccination programme. This demand further increased the pressure on endoscopy services across the system.

In November 2020 the list had grown to almost 3,000 patients across all pathways waiting over six weeks. This increase in waiting times created a risk of potential serious harm for patients. If early intervention of bowel cancer is missed, a patient’s survival rate is reduced.

What the system did

Assembled a recovery group

The STP knew collaborative partnership working would be pivotal to the success of restoring endoscopy services across Coventry and Warwickshire.  A recovery group was assembled consisting of clinical and operational representatives from University Hospitals Coventry and Warwickshire, George Eliot Hospital and South Warwickshire Foundation Trust to review the situation and to plan the response.

Signed a mutual aid agreement

Historically, there has been no previous cross-provider working in endoscopy and these new relationships were forged from across the various provider organisations in a relatively short period of time. A mutual aid agreement was signed off by chief officers which formalised the process of supporting partner trusts to work more closely together. This agreement meant that trusts could actively support each other with demand issues.

Created a virtual room

Due to social distancing restrictions, a virtual ‘room’ was created to bring key people together to meet as a team and discuss issues and solutions. This virtual room also provided a space for escalating issues to chief officers, as required.

Identified all available capacity

Available capacity was identified across all endoscopy units, so if one unit was pressured, patients could be offered the alternative of going to another unit and being seen more quickly. Private hospitals provided additional support, further increasing our overall capacity to deliver procedures.

Put standard operating procedures in place

To ensure that the collaborative working was efficient, standard operating procedures were put into place. These procedures allowed patients and consultants from other trusts to move around the system. This helped patients to be seen more quickly and helped consultants familiarise themselves with the different settings.

Identified alternative clinical procedures

Alternative clinical procedures were also identified, such as computed tomography (CT) colonoscopy, also known as a virtual colonoscopy. This helps to reduce the waiting lists for pressured pathways by offering a quicker alternative for suitable patients.

Results and benefits

Through working in partnership to increase capacity and exploring new ways of working, the system was able to support patients to access endoscopy services more quickly, improving their chance of benefiting from early intervention. By March 2021 there were just 176 patients waiting over six weeks, a reduction of over 90 per cent, delivered in just over four months.

What's next?

The learnings from the project have been used to draft a long-term plan to maintain success and to inform future projects.

New initiatives are in development to support longer term sustainability. These include delivering virtual colonoscopy, nasal endoscopy, FIT and new endoscopy rooms.

Obstacles faced

• Some patients were not always keen to move to another site.
• IT issues requiring a specific person to support clinicians, without which it may not have worked as well as it did.
• Doctors were required to travel across sites.
• Tracking patients (particularly for computed tomography colonoscopy).

Takeaway tips

• Administration is important to ensure patients are booked onto all available lists to reduce missed opportunities. Trusts with available capacity must communicate clearly to the admin team at other trusts to avoid any delays with treating patients.

• Data accuracy and interpretation needs to be as clear as possible. Decisions concerning patient care are largely based on these numbers, which affects their lives and survivability. 

• Cancelled sessions must be filled with enough notice to avoid delays with running a patient list. Trusts can liaise with each other to use the available capacity.