1. Please provide copies of protocols and procedures in use and rotation in the Trust’s Gastroenterology department, relating to Barrett’s Oesophagus, since March 2013
No set Trust protocols exist.
In the endoscopy department and in gastroenterology clinic Royal Surrey County Hospital NHS Foundation Trust follow national guidelines published by the British Society of Gastroenterology (BSG) in relation to Barrett’s oesophagus and reiterated in the recently published BSG quality standards of upper gastrointestinal endoscopy.
Documents are attached.
2. Please provide copies of protocols and procedures in use and rotation in the Trust’s Gastroenterology department since March 2013, relating to the diagnosis, management and monitoring of patients diagnosed with Barrett’s Oesophagus
Whilst no Trust specific protocols exist since March 2013, Royal Surrey County Hospital NHS Foundation Trust attaches a flow chart summarising the process for repeat or surveillance procedures within the Department (q2 attachment). We are guided by national BSG guidelines (attached).
Diagnosis: BSG guidelines state the biopsy protocol – targeted biopsies of visible lesions and Seattle protocol biopsies and reporting with the Prague classification with corroborative biopsy results.
Management: BSG guidelines state acid suppression to control reflux symptoms and repeat endoscopy at 2 to 3 years depending on findings on endoscopy.
Monitoring: with 2 to 3 years endoscopy and biopsies taken at endoscopy.
3. Please provide copies of any protocol and guidance that relate to the supervision of junior doctors performing gastroscopy procedures since March 2013
No Trust specific protocols exist.
We are guided by national standards set by JAG – attached.
That states that endoscopy trainees are supervised by endoscopy list consultants unless they are already accredited by JAG in upper GI endoscopy, in which case they are independent endoscopists.
4. Please provide copies of the protocols, procedure and precedent letters used when contacting patients to advise them that they are to be recalled for review despite being discharged from the Gastroenterology department in error
No protocol, procedure or letter exists to recall patients discharged in error. No such guidance or standard is available by national bodies BSG/JAG
(i) Recall of patients is usually for earlier endoscopy/further management if abnormal results are seen at the time of endoscopy or on histology, as per clinical indication.
(ii) Abnormal histology e.g. confirmed low grade dysplasia, high grade dysplasia and oesophageal cancer are referred and discussed at the oesophago- gastric multidisciplinary meeting to plan further management as per national guidelines.
(iii) If a patient is discharged from surveillance in error at the time of endoscopy and no biopsies were taken, there is no process to track discharged patient as he returns to the care of his GP, unless himself/herself or their GP refers the patient back.
No protocol, procedure or letter exists to recall patients discharged in error.
There is no further review to re-enter the Barrett’s surveillance program if discharged in error as there is no system to capture that information unless:
(i) patient self refers
(ii) GP re-refers
(iii) new symptoms/ clinical indication arises or patient has follow up for clinic review
5. Please advise as to the number of patients incorrectly discharged from the Gastroenterology department in the academic year from 2012-2013 and subsequently recalled for review
This data are not available and there are no processes to capture these; no such requirement has been stated by regulatory bodies such as BSG and JAG.
6. Please provide copies of auditing documents and procedures in use and rotation since March 2013 that relate to the supervision of junior staff performing Gastroscopy procedures
There are no Trust auditing documents or procedures for supervision of trainees in endoscopy.
Training standards are produced by the national regulatory body JAG (see attached above) and its endoscopy training system (JETS) and each trainee has to complete log of successful procedures.