|Title:||Clinical guidelines for the management of the public upper gastrointestinal endoscopy wait list|
|Document ID:||Operational Circular OP 1927/05|
|Date of issue:||Thursday, 17 March 2005|
|Status:||NO LONGER APPLICABLE|
|Description:||This Operational Circular details the clinical guidelines to be followed when placing patients on the public waitlist for upper gastrointestinal endoscopy.|
|Applicable to:||Clinical and administrative staff of the Department of Health|
|Period of effect:||from 21 March 2005|
|Authorised by:||Dr Andrew Robertson, Acting Group Director, Statewide Policy Division, 14-Mar-2005|
|Print version:||View print version|
Clinical guidelines for the management of the public upper gastrointestinal endoscopy wait list
This Circular details the clinical guidelines to be followed when placing patients on the public waitlist for upper gastrointestinal (GI) endoscopy.
Clinicians performing upper GI endoscopy in the public health sector must be properly credentialed by the health service in which they practice. Credentials include formal qualifications, evidence of training, of experience and of the clinical competence of the health care professional 1.
The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy is a national body comprising representatives from the Gastroenterological Society of Australia (GESA), the Royal Australasian College of Physicians (RACP) and the Royal Australasian College of Surgeons (RACS). The Committee recognises training of endoscopists who have completed their training in Australia or who are now practicing in Australia. An updated register of all endoscopists whose training has been recognised is maintained at the secretariat 2. Evidence of registration with the conjoint committee must be considered by health service credentialing committees.
Endoscopy on children should only be performed by endoscopists who have received specific paediatric training.
The pre-preprocedure assessment of the endoscopy patient should be performed either by the endoscopist who is to perform the procedure, or by a suitably credentialed colleague, or by the referring practitioner (direct access endoscopy). Assessment will include the need for endoscopy, the patient's suitability for day surgery and the urgency of the situation. All patients undergoing endoscopic procedures require pre-procedural evaluation to assess their risk and to help manage problems related to pre-existing medical conditions. A history and focused physical examination, review of current medications and drug allergies, as well as an assessment of cardiopulmonary status at the time of the procedure are necessary to adequately provide for the safety of the patient.
In many instances the General Practitioner or referring specialist will have undertaken an assessment of the patient's suitability for direct access endoscopy. A written referral of this type will suffice as long as a credentialed endoscopist considers that the prime issues are addressed and that major changes in the patient's condition are not likely to occur prior to the date of endoscopy.
Addition to Public Waitlist for Upper Gastrointestinal Endoscopy
Clinicians should be mindful of published indications for upper GI endoscopy when considering which patients should be listed for the procedure. For example:
Table 1. Appropriate and inappropriate indications for endoscopy in dyspepsia 3
Other symptoms/conditions/tests requiring upper GI endoscopy3
Addition to waitlist
Following identification of a problem requiring endoscopic assessment and assessment of the patient's suitability and consent for endoscopy, the patient may be added to the public waitlist for upper GI endoscopy. The addition of a patient to the waitlist should be on the basis of clinical guidelines and only when the patient is at ready-for-care status. Clinical audits of the endoscopy waitlist will be undertaken on a regular basis and any patients not ready for endoscopy will be removed from the waitlist.
Assessment of urgency
Facilities and staffing
Health services performing endoscopy should ensure that their facilities and staffing promote patient safety and service quality. GESA has published facilities and service standards which provide a useful basis for this assessment 6, although local circumstances must be taken into account. Cleaning and disinfection facilities and training of relevant staff should conform to the relevant GESA guidelines 7.
Sedation for endoscopy
The College of Anaesthetists (ANZCA), GESA and the Royal Australian College of Surgeons have recommended 8 that during an endoscopy procedure, a person must be present who is trained in acute resuscitative measures and whose principal responsibility will be to monitor the patient's level of consciousness and cardiorespiratory status and assist resuscitation if required. If major risk factors are identified or difficulties can be anticipated, involvement of an anaesthetist is recommended.
Endoscopic retrograde cholangiopancreatography (ERCP)
Patients being considered for ERCP must undergo formal review by a credentialed endoscopist prior to being listed for the procedure. Direct access referral for ERCP will not be permitted.
It is strongly advised that patients undergoing ERCP have an anaesthetist present, since the room is dark, heavy sedation is required and patients lie semi-prone.
Dr Andrew Robertson
This circular last updated: Thursday, 17 March 2005 at 12:00am