Follow up of patients with colorectal polyps: are the BSG guidelines being adhered to?

Pickard, Michael D.; Dewar, E. P.; Kapadia, Rupa; Khan, Raja B.; Hutchinson, I. F.; Nejim, Ali

doi:10.1111/j.1463-1318.2006.01180.x

Cited by 14 publications

(12 citation statements)

References 6 publications

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“…Pickard et al. demonstrated in their review that only 14.8% of patients were on the waiting list in accordance with the BSG guidelines [9]. Our results are similar, finding the figure to be 10%.…”

Section: Discussionsupporting

confidence: 87%

“…Mysliwiec et al demonstrated that some surveillance colonoscopy is inappropriately performed, and in excess of guidelines, particularly in the case of hyperplastic polyps and low-risk lesions such as a small adenoma [7], indeed a retrospective review of all colonoscopies carried out in a 3-month period by Thomas et al has shown that strict adherence to the guidelines would have caused a 47% reduction in surveillance colonoscopies [8]. Pickard et al demonstrated in their review that only 14.8% of patients were on the waiting list in accordance with the BSG guidelines [9]. Our results are similar, finding the figure to be 10%.…”

Section: Discussionmentioning

confidence: 99%

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Application of the BSG guidelines to a colonoscopy waiting list

Clements¹,

Tawfiq²,

Harries³

et al. 2009

Colorectal Disease

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Objective Currently priority for colonoscopy is given to diagnostic and therapeutic procedures. Surveillance colonoscopies place a significant demand on the service. These are held on a separate waiting list in our institution, which is currently several years behind. The purpose of this study was to apply the BSG guidelines to this waiting list in our institution in order to ascertain whether patients are appropriately listed. Method This was a retrospective review. The patients on the waiting list whose procedures were due in 2004 and 2005 formed the study group. Information on demographics, previous colonoscopies, and indication was taken from the case notes. Results were analysed using Microsoft Excel. Results A total of 172 patients were overdue their colonoscopies. If the BSG guidelines were strictly adhered to, 49% of these patients were inappropriately listed. If applied less rigidly, 42% of patients should not have been on the list. The reasons for removal from the list were as follows: Thirty-nine patients were older than the upper age limit, 23 had had clear colonoscopies after adenomatous polyp follow up, four were listed for diverticular disease follow up, four for metaplastic polyps, one for constipation and one for per rectum (PR) bleed follow up. Conclusion With strict application of the BSG guidelines to a surveillance colonoscopy waiting list, 49% of the patients on the list do not need the procedure. It is recommended that consultant led education and control of the waiting list be used to reduce unnecessary investigations.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Application of the BSG guidelines to a colonoscopy waiting list

Clements¹,

Tawfiq²,

Harries³

et al. 2009

Colorectal Disease

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“…Guidelines are followed inconsistently in a wide range of clinical circumstances. 15,16 In the NHS the impact of other NPSA safety alerts has been inconsistent. 17,18 The reasons for alerts and guidelines not being adopted are complex.…”

Section: Possible Solutionsmentioning

confidence: 99%

Patient safety matters: reducing the risks of nasogastric tubes

Yardley¹,

Donaldson²

2010

Clinical Medicine

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-Nasogastric tube insertion is a common clinical procedure carried out by doctors and nurses in NHS hospitals daily. For the last 30 years, there have been reports in the medical literature of deaths and other harm resulting from misplaced nasogastric tubes, most commonly associated with feed entering the pulmonary system. In 2005 the National Patient Safety Agency in England assembled reports of 11 deaths and one incident of serious harm from wrong insertion of nasogastric tubes over a two-year period. The agency issued a safety alert setting out evidence-based practice for checking tube placement. In the two and a half years following this alert the problem persisted with a further five deaths and six instances of serious harm due to nasogastric tube misplacement. This is a potentially preventable error but safety alerts advocating best practice do not appear to reliably reduce risk. Alternative solutions, such as standardising procedures, may be more effective.KEY WORDS: nasogastric tube, patient safety, safety alert IntroductionPhysicians have been intubating the gastrointestinal tract to allow artificial feeding since ancient times. 1 Today over 275,000 nasogastric tubes are supplied to the NHS annually (personal communication, NHS Supply Chain, May 2009). As with most medical procedures, there are risks to the use of these tubes. Some complications (eg epistaxis) are common and minor, others (eg oesophageal perforation and pneumothorax) are rare but serious.In recent years patient safety has emerged as a major issue of concern to healthcare providers. 2 Various approaches to improving safety have been used, including attempts to apply the experience of safety experts from other industries to hospital care. Over time, understanding of what approaches have most impact on reducing medical errors has grown. In this paper, the nature and scale of the problem of nasogastric tubes in England is reviewed. The limited impact of a safety alert is highlighted and the issue of nasogastric tube safety is used to illustrate other approaches to improving patient safety. Problems of nasogastric tubes in the NHSIn April 2004, an inquest was held into the unexpected death of an eight-year-old girl in an NHS hospital in England. She had required intubation and ventilation due to respiratory failure and was temporarily unable to eat or drink. A nasogastric tube was passed to administer enteral feed. The position of the tube was checked with the whoosh test (auscultating the epigastrium for bubbling as air is injected down the tube) and litmus testing of the aspirate. The whoosh test was positive while the aspirate from the tube turned blue litmus paper pink, suggesting gastric acidity. The tip had in fact punctured the pleura to lie in the pleural cavity. When enteral feed was administered through the tube her respiratory function worsened. The whoosh and litmus paper test were repeated. Again, they appeared to confirm the positioning of the tube in the stomach. Feeding continued and the girl died. At post mortem a l...

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“…A growing body of data suggests that gastroenterologists often recommend repeat colonoscopy for colonic polyp surveillance more frequently than guidelines recommend [2–6]. Overuse of colonoscopy for polyp surveillance poses a significant economic burden, [7] may contribute to decreased colonoscopy capacity for initial screening, and increases the risk of complications [8, 9].…”

Section: Introductionmentioning

confidence: 99%