Adapting a 2-week-wait colorectal service in the pandemic using the quantitative faecal immunochemical test.

The coronavirus pandemic has brought about an economic and healthcare crisis. This has resulted in delays in virtually all areas of patient care and has forced clinicians to review and adapt their processes, in order to ensure patients continue to have access to timely and effective services. In the author's local Trust, this manifested in altered protocols, developed in order to maintain patient and staff safety while conducting invasive and potentially virus-spreading investigations. A new (temporary) standard operating procedure was developed in conjunction with Cancer Alliance South West to introduce the quantitative faecal immunochemical test (qFIT) as an indicator for diagnostic testing after the majority of diagnostic services were suspended or drastically reduced. Patients would then have their investigation(s) deferred on the basis of a negative result (<10 mcg Hb/g). This cohort (n=120) were revisited once diagnostic services were resumed and referred for CT examination. Audits carried out on the data showed that nine cancers had been identified in the negative qFIT population (lung, prostate, breast, bladder, small bowel carcinoid, oesophageal and three occurrences of caecal carcinoma. This article provides an overview of the experiences and outcomes of a colorectal 2-week-wait service in response to this global pandemic and how this experience will shape the service in the future.

Setting up a nurse-led bowel 'two week wait' service.

Patients who present to their GP with 'red flag' symptoms for possible bowel cancer (such as change in bowel habit or rectal bleeding) are urgently referred to an acute trust as a '2 week wait' (2WW) patient and require assessment and investigation in an efficient and timely manner. The burden that is created by ever increasing numbers of referrals requires a service that is reliable and flexible in meeting demand. This article presents the development of a nurse-led 2WW service that was implemented as a direct result of this pressure. The development of the national guideline is discussed and the rationale for a nurse-led service is provided, along with the processes followed to ensure patient safety. The inclusion of a telephone side to service provision is also examined and the challenges faced by the team are discussed.

Patient satisfaction with clinicians in colorectal 2-week wait clinics.

AIM: To determine if patient satisfaction is affected by the clinician (nurse or doctor), conducting the colorectal 2-week wait (2ww) clinics. METHODS: A prospective non-randomised comparative cohort study of 339 consecutive patients (divided by blind allocation into nurse-led (n=216) and doctor-led (n=123) cohorts) conducted over a 3-month period. Patient satisfaction in both cohorts was assessed by an adapted version of the Grogan et al validated patient satisfaction questionnaire. The questionnaire was piloted first and was found to have high internal reliability (Cronbach's alpha=0.91). RESULTS: The study had a response rate of 78% (n=258/331) and overall satisfaction scores showed 85% (n=149/175) of patients in the nurse-led cohort and 65% (n=54/83) of patients in the doctor-led cohort strongly agreed that they were satisfied with the care they received. Mean overall satisfaction scores in the two cohorts revealed that the nurse-led cohort achieved significantly more 'strongly agree' responses than the doctor-led cohort (p<0.001, CI: 95%). Further analysis of the responses to each question demonstrated statistical significance when comparing the two cohorts. CONCLUSIONS: The study offered patients the opportunity to reflect on service delivery enabling a more responsive approach to health care within the colorectal 2ww service. It found that patient satisfaction was affected by the clinician conducting the 2ww clinic, in that the nurse-led cohort displayed significantly higher patient satisfaction. However, there are areas that merit further research.

Anti-embolism stockings: are they used effectively and correctly?

Anti-embolism stockings are widely advocated in the prevention of deep vein thrombosis. But do they do more harm than good? This article explores the effectiveness of this intervention and the possible link with heel pressure ulceration, an increasing problem which costs the NHS millions of pounds and causes suffering to patients. With the aid of an audit tool the author assesses nursing knowledge and reveals that, although there is a high level of understanding regarding post-application care, the appropriate initiation of the intervention and subsequent documentation of this intervention are severely lacking, leaving the health profession wide open to litigation.