Gastrointestinal Endoscopy service

You will be admitted to the Ryles Day Care Unit, which is located on the second floor of the hospital. The endoscopy unit is located in the neighbouring operating department.

Endoscopy services are provided during morning and afternoon sessions routinely on weekdays, and there is no out-of-hours emergency service.

Gastrointestinal endoscopy procedures offered:

• Oesophago-gastro-duodenoscopy (OGD) – to look inside the gullet (oesophagus), stomach and the first part of the small intestine immediately beyond the stomach (duodenum).
• Colonoscopy – to look inside the large intestine (from the rectum to the caecum).
• Sigmoidoscopy – to look inside the final part of the large intestine (from the rectum to the top of the descending colon).

Private patient referrals (whether self-funding or private medical insurance) are made to a consultant gastroenterologist, upper gastrointestinal tract or colorectal surgeon and the decision to proceed to an endoscopy procedure is made during an initial or follow-up outpatient consultation.

NHS-funded patients can choose to be referred to The Montefiore Hospital, and these referrals are accepted through the NHS electronic referral system (ERS). Waiting times are managed in accordance with national standards.

The endoscopy service is an outsourced provider of services for patients who require bowel cancer screening (as part of the national Bowel Cancer Screening Programme) and who have first seen a specialist bowel screening practitioner.

Bookings for admission require at least 2 weeks’ notice, although every effort will be made to accommodate a short-notice booking where this can occur safely.

Admission criteria
If you are having sedation or general anaesthesia, you will be required to arrange for a responsible adult to collect you from hospital and you must also have a responsible adult stay with you overnight. Depending on the type of medication used, you may not be able to drink alcohol, drive a car, operate machinery or sign legally binding documents for 24 hours after your procedure.

For admission to the day care unit, you must not require overnight stay and, where colonoscopy is planned, you must be able to self-manage the required oral bowel cleansing regime at home before your admission.

At the point of first contact with the hospital, you will be asked if you have any communication support needs, so that we can make arrangements to appropriately support any disability, impairment or sensory loss.

If necessary, we have access to a world-wide interpretation service (including British Sign Language), and a translation service is available to provide any written information in other languages and formats (such as large font, easy read or Braille).

Elements of the pre-admission process will require your interaction with a software platform called LifeBox. Digital assistance is available if required.

The hospital was designed to support access by anyone with a physical disability.

You can expect to receive safe, quality-assured care from a competent, multidisciplinary team who work alongside consultant endoscopists.

The endoscopy service team have developed a service pledge for patients, found at the back of this booklet.

If you are interested to see who our team are, there is a team photo board in the day care unit.

The service is working towards accreditation provided by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG), which evaluates the quality of endoscopy services against a quality framework.

The endoscopy service utilises all available opportunities to drive continuous quality improvement, using the following:

• Patient experience feedback.
• Learning from the investigation into adverse events.
• Review of key performance indicator data.
• Clinical audit results.
• Utilisation of external learning.
• Quality reviews with affiliated services.

We’re Listening To You!
We want you to have the best possible experience of our service.

Should you have any cause for concern whilst you are with us, please do not hesitate to ask to speak to the nurse in charge of the day care unit or to the Day Care Unit Sister, either of whom will do their best to address the issue.

We value patient feedback to help us continually improve our service. After your endoscopy procedure, and before you leave the day care unit, you will be asked to complete a survey questionnaire. Please take this opportunity to tell us about your experience.

If you are interested to know how patient feedback has already influenced our service, there is a ‘You Said, We Did’ poster displayed in the day care unit.

If you do have cause to complain, your complaint will be taken seriously and managed in accordance with our complaints procedure.

Around the hospital, we have ‘We’re Listening To You’ booklets available for pick-up, which include information about the complaints process.

National Endoscopy Database
After your procedure, the consultant endoscopist will log data about your procedure into an endoscopy reporting system, which is linked to the National Endoscopy Database (NED). Note that none of your personal details are shared, so you cannot be identified.

The NED aims to improve the quality of endoscopy in the UK by procedure data from over 400 endoscopy units into one central database. The NED aims to address unwanted variation in endoscopy performance by providing access to highly detailed and robust performance analytics and reports, benchmarked against national standards.

With NED, endoscopists can easily review their own key performance indicators (KPI’s) set against the British Society of Gastroenterology’s (BSG) standards.

The NED is a joint initiative between the Joint Advisory Group in gastrointestinal endoscopy (JAG), British Society of Gastroenterology (BSG), Association of Upper Gastrointestinal Surgeons (AUGIS) and Association of Coloproctology of Great Britain and Ireland (ACPGBI), owned by the Royal College of Physicians (RCP).

For more information, please see the NED website: https://ned.thejag.org.uk

• You will be welcomed to our service and receive a personalised experience. Your best interests will always be at the heart of everything we do.
• You will receive high quality and safe care from a competent team, who are committed to clinical excellence.
• You will be treated with respect and dignity, and we will ensure that your care takes account of your individual needs and preferences. We respect diversity and personal choice, and stand up to and challenge disrespectful behaviours in others.
• Your privacy will be upheld at all times, and we will behave in a discreet and confidential manner whenever we handle information that is personal to you. We will also adhere to gender segregation rules.
• You will be treated with utmost professionalism and compassion, whilst also respecting your personal boundaries. Caring is our passion.
• You will know what to expect at all times and have the information you need to make decisions about your own care and treatment.
• We will make navigating our service as straightforward as possible.
• You can expect us to always communicate honestly with you, and we will listen to you so that we know what you need from us. We will use your feedback to continually improve our service.

When our admissions team receive a procedure booking form from your consultant, they will contact you to arrange an admission date.

You will be set up with a LifeBox account, and asked to login from home to complete an electronic health questionnaire. In LifeBox, you will find that procedure information is available to you in both written and video formats. Should you require this information to be provided in any other format, please just let the admissions team know.

Your admission is conditional and requires completion of pre-procedure assessment, to ensure that you meet the hospital’s admission criteria and are fully prepared for the planned procedure. The intensity of the pre-procedure assessment process will depend on your health status and the type of anaesthesia to be used during the procedure. It is likely that you will be required to attend the hospital outpatient department for some tests, and then have a telephone conversation with one of our assessment nurses. At this time, please feel free to ask any questions that you have.

If you are having colonoscopy, you will be given an oral preparation to be taken the day before your admission, which will clear and clean your bowel. You will be given full instructions about how to take this, including a work-up diet, and what to expect.

The assessment nurse will ensure that you have all necessary instructions regarding medications that you usually take.

You will receive either a telephone call or text message from our admissions team, to give you an exact arrival time. Arrival times are carefully determined to allow sufficient time for pre-procedure preparations whilst also minimising the amount of time that you have to spend waiting.

When you arrive at the hospital, you will check in at the main reception desk and then be escorted to the day care unit.

You will be shown into a private room, which has a chair and media hub to help you pass the time whilst waiting, and you will meet the nurse who is assigned to look after you. The nurse will ensure that you are fully prepared for your procedure, and you will be asked to change into a gown. You will be offered disposable pants to wear in accordance with your preference.

Please feel free to bring a laptop, mobile phone or other device with you to help pass the time; you will be assigned a locker to keep your personal effects safe whilst you are having the planned procedure.

Whilst waiting in the day care unit, you will be visited by your consultant who will discuss the planned procedure and ask you to sign an agreement (consent) form. This is an opportunity for you to ask any more questions that you have. If you are having a general anaesthetic or enhanced sedation, you will also meet the anaesthetist.

An intravenous cannula will be inserted into one of your veins to allow intravenous medications to be given during your procedure.

An Operating Department Practitioner (ODP) will come to the day care unit to take you to the endoscopy room. You will be given a robe and slippers to wear and will usually walk the short distance through the operating department into the endoscopy room.

Once in the endoscopy room, you will again see your consultant, who will perform the procedure, and be introduced to the other team members:
• An endoscopy assistant, who will work closely with the consultant performing the planned procedure.
• A circulating practitioner, whose main role is to act as a runner for anything that is required during the procedure.

The main role of the ODP is to support you during the procedure and ensure that you are as comfortable as possible.

First, you will be asked to make yourself comfortable on the procedure trolley and the ODP will then attach you to monitoring equipment.

A number of safety checks will be performed before the procedure starts.

Our endoscopy team will do their best to ensure that you are as comfortable as possible during the procedure. There are various ways in which we can support your comfort and these will be discussed with you before your admission so that you have the opportunity to decide the best option for you.

Your comfort will be monitored during the procedure by the ODP, and feedback given to the consultant endoscopist. You have the right to ask for the procedure to be paused or stopped at any time, and the ODP can communicate to the consultant endoscopist on your behalf as necessary.

We regularly audit patient comfort scores, and individual endoscopists are given feedback about their performance in this respect. It is important to us that you have the best possible experience during your endoscopy procedure.

Immediately after the procedure, you will remain in the endoscopy room until the team have completed all of their records about your procedure. Depending on the type of anaesthesia used, you will then be transferred to either the recovery unit or to the recovery side of the day care unit. If you do spend a short period in the recovery unit, you will then be transferred to the recovery side of the day care unit where you will remain until you are ready to go home. In the recovery side of the day care unit, you will be nursed in a single-occupancy partitioned bay. For your privacy and dignity, we comply with gender segregation requirements.

You will be able to go home when the nurse determines that it is safe for you to do so. You will usually need to meet the following discharge criteria:
• You have had something to eat and drink (if you have had a local anaesthetic throat spray, you will not be offered anything to eat or drink for an hour afterwards).
• You have passed urine.
• You have suffered no ill-effect of the procedure and are comfortable
• You are happy to be discharged.
• You are collected by a responsible adult, and you have an adult to stay with you overnight (not necessary if you have only had local anaesthesia, e.g. throat spray).

Before you go home, someone will let you know if any follow-up arrangements are required.
Your nurse will ensure that you understand what signs of complication to look out for and what to do in the event of any complication arising or if you have any questions or concerns.

If you have been prescribed any new medication to take home, this can usually be dispensed by the hospital pharmacy.

A summary of your procedure will be sent to your GP and a copy of this given to you.

If you have any questions or concerns, please do not hesitate to contact us, at any time of day or night, using the contact details provided to you at the time of discharge.

Please contact us with any concern, even if you think it’s trivial, and report any of the following things to us without delay:
- heavy bleeding from your bottom, or bleeding that’s getting worse
- stool that’s dark or black, like tar
- severe stomach pain, or pain that is getting worse
- a high temperature, or you feel hot or shivery
- unusual shortness of breath
- you keep being sick