direct access flexible sigmoidoscopy pathway for gps complete referral form and fax to st george’s...
TRANSCRIPT
Direct Access Flexible Sigmoidoscopy Pathway for GPs
Complete referral form and fax to St George’s Healthcare NHS Trust within 24 hours Fax Number: 020 8725 0778Tel Number: 020 8725 [email protected]
• Hospital to contact patient by phone to arrange appointment• Hospital arranges home enema with District Nurse (if required)• Endoscopy appointment booked• Confirmation sent to patient and GP • Transport/interpreter arranged (if required)
Patient attends endoscopy appointmentPre-assessment with nurse endoscopist Flexible sigmoidoscopy
Patients 50+LGI 1 Rectal bleeding with or without anal symptoms and no change in bowel habit for 6 weeks or moreLGI 2 Rectal bleeding with change in bowel habit (increased frequency/increased looseness) for 6 weeks or moreLGI 3 Change in bowel habit for 6 weeks or more (increased frequency/increased looseness) without rectal bleeding
Patients of any ageLGI 4 Palpable rectal mass
Letter to GP within 5 days with outcome of consultation
Cancer SuspectedEnter colorectal pathwayFurther investigationsDiscuss at colorectal MDT
Cancer not suspectedDischarge back to GP
If referral to other speciality is indicated, follow current Trust policyAdvice and/or treatment may be offered for haemorrhoids or minor conditions
Letter to GP within 5 days with outcome of consultation
DNAdischarge back to GP
Enema at home
Polyp detected
Adenoma Hyperplastic
BookColonoscopy
Letter to GP within 5 days with outcome of consultation
2 Week Rule Colorectal ClinicLGI 5 Right lower abdominal mass consistent with involvement of the large bowelLGI 6 Unexplained iron deficiency anaemia Men HB< 11g/dl Post menopausal women < 10g/dl
Referral to:St George’s Healthcare NHS TrustFax Number: 020 8725 0778Tel Number: 020 8725 [email protected]
EXCLUSIONS FROM THE DIRECT ACCESS SIGMOIDOSCOPY PATHWAYPatients with constipationUnexplained iron deficiency anaemiaLower abdominal massSignificant co-morbidities (respiratory, cardiac, renal or neurological)Patients who have had an endoscopic investigation (colonoscopy/flexible sigmoidoscopy) within the last 2 years
Patients without mental capacity to consentPatients who are already under investigation for suspected cancer Patients with existing inflammatory bowel diseasePatients with known infective diarrhoeaPatients who will require an overnight stay
Provide Patient Information and Consent Form Issue an enema prescriptionAssess patient for self-administration. If inappropriate, Endoscopy Unit will arrange District Nurse visit to administer to patient
Rapid Access Proctology Clinic 16-50LGI 1 Rectal bleeding with or without anal symptoms and no change in bowel habit for 6 weeks or moreLGI 2 Rectal bleeding with change in bowel habit (increased frequency/increased looseness) for 6 weeks or moreLGI 3 Change in bowel habit for 6 weeks or more (increased frequency/increased looseness) without rectal bleedingLGI 4 Palpable rectal massLGI 5 Right lower abdominal mass consistent with involvement of the large bowelLGI 6 Unexplained iron deficiency anaemia Men HB< 11g/dl Post menopausal women < 10g/dl
Patient arrives at the Unit with a referral letter from GP