P264 Barrett’s oesophagus service delivery at a district general hospital in the North East of England

Abstract

<h3>Introduction</h3> Standards for management of Barrett’s Oesophagus (BO) in the UK are outlined in the relevant British Society of Gastroenterology (BSG) guidelines. Each organisation should have a dedicated Barrett’s Team (BT) to facilitate delivery of a high quality service, from a clinical but also an administrative perspective. Our audit was designed to assess the administrative performance of the Barrett’s service in our Trust. <h3>Methods</h3> The audit was undertaken in two 6-month cycles from September 2020 to September 2021. Data was collected by reviewing endoscopy reports, histology and clinic letters. Service provision was assessed against the following standards: 1. All endoscopists diagnosing BO should copy the BT in the endoscopy report 2. All patients should receive a histology results letter, copied to the BT 3. All patients with a new diagnosis of BO should be offered a one–off outpatient clinic review 4. All patients with a new diagnosis of BO should be made aware of the premalignant nature of their diagnosis; this should be documented in relevant correspondence with the patient Results were disseminated to responsible clinical teams after the 1^st and 2^nd cycles. Practice outliers were directly contacted by the Endoscopy Clinical Lead, as per standard governance process when audits identify trends. A refresher training session on Barrett’s clinical and local administrative management was delivered in between cycles. <h3>Results</h3> The<b><i>1^st cycle</i></b> of the audit captured data from September 2020 to March 2021 inclusive. 231 patients were identified and 219 were eventually included. The BT were copied in 140 (65%) of endoscopy reports. Although 191 (89%) of cases had a histology results letter, only 110 (68%) of these letters were copied to the BT. 60 (27%) patients received a new diagnosis of BO, 17 (28%) of which were either discharged due to lack of true BO on review, or went on to a dysplasia/cancer pathway following index gastroscopy. of the remaining 43 patients, 22 (55%) had a new outpatient clinic requested on endoscopy report. Of the 60 new BO patients, 34 (57%) eventually received some type of BO-related correspondence/clinic review but only in 18 (53%) of these cases a discussion around the premalignant nature of BO was formally documented. The <b><i>2nd cycle</i></b> of the audit identified 201 patients from April 2021 to September 2021; 181 patients were eventually included. The BT were copied in 125 (70%) of endoscopy reports. 145 (81%) of the patients had a histology letter sent but the BT were copied in only 97 (64%) of these letters. 32 (18%) patients received a new diagnosis of BO, from which 5 did not warrant clinic review due to lack of true BO on review. of the remaining 27 new BO patients, 16 (60%) had an outpatient clinic requested on endoscopy report. Of the 32 new BO patients, 21 (66%) eventually received some type of BO-related correspondence/clinic review but only in 17 (81%) cases a discussion around the premalignant nature of BO was formally documented. Results are summarized in the following chart: <h3>Conclusions</h3> Administrative management of Barrett’s oesophagus on a Trust level is equally important to adequate clinical management of the condition. This audit highlights that even when a local BT exists, engagement of the wider team of clinicians is key in ensuring patients receive appropriate follow up and are aware of the implications of their Barrett’s diagnosis. Endoscopists and responsible consultants need to implement these simple measures to their practice, to ensure BO patients are brought to the BT’s attention. When the 2^nd cycle was performed, despite dissemination of results of the 1^st cycle, delivery of a refresher training session and direct feedback to practice outliers, it was obvious that we are far from the goal of 100% for all audit standards. These gaps highlight a risk of patients being lost to follow up and GPs/patients not chasing recommended surveillance plans due to lack of awareness of the premalignant nature of BO. Further work is needed within individual Trusts to address human factors affecting high quality delivery of a BO service. Automation of the process of BT involvement whenever BO is mentioned in an endoscopy/histology report would offer a solid safety net in management of these patients.