P283 Edinburgh dysphagia score safely prioritises endoscopy in a nurse led telephone triage clinic. (19th June 2022)

• Record Type: Journal Article
• Authors: Winter, Jack; Glen, Paul; Rae, Nicky; Pasieka, Sister Maree; Miller, Paul; Morris, John
• Is Part Of: Gut. Volume 71(2022)Supplement 1
• Page Start: A177
• Page End: A178
• Publication Date: 2022-06-19
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2022-BSG.336
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: As part of the COVID recovery strategy, the GI unit in North Sector of GGC set up a telephone clinic manned by experienced endoscopy nurse specialists to triage urgency of dysphagia investigation by undertaking symptom assessment and utilising the Edinburgh Dysphagia Score (EDS). Patients with high EDS were vetted to (the highest) Category 1 (of 4) priority, and patients with low EDS were investigated at Category 2. The outcomes for all patients referred with dysphagia over a 6 month period commencing January 2021 were audited to determine the safety and clinical value of maintaining this approach in the longer term. Methods: Information on all patients referred to the service was prospectively collected using a shared MS Teams Excel spreadsheet. We collected information on the EDS at interview, the decision to investigate and the designated priority of the investigation. Electronic cases records were then interrogated to ascertain the outcome of investigations. Statistical comparison of the frequency of diagnoses made at endoscopy was undertaken using the CHI square test. Results: 296 patients were assessed via 40 nurse dysphagia triage clinics during this period, with 266 undergoing endoscopy. Only 14/296 (6.4%) patients avoided endoscopy solely on account nurse assessment and reassurance. Relative diagnostic frequency is detailed in table 1 . 144 (48.6%) were triaged to Category 1 endoscopy and 122 (41.2%) to category 2 endoscopy. Oesophageal cancer was diagnosed in 9/128 (7%) patients with EDS ≥ 3.5 and only 1/106 with EDS < 3.5 (p<0.05). For all other diagnoses there was no significant difference in frequency between those with high or low EDS. 59% of all patients had no new gastroesophageal diagnosis made. New diagnosis of Barrett's oesophagus was uncommon, being found in 2.6%. Conclusions: Routine use of the Edinburgh Dysphagia score can safely and effectively prioritise dysphagia investigation. While this can be delivered via a telephone triage clinic run by experienced nurse endoscopists, such an approach rarely avoids endoscopy and with the return of capacity the nurses may be better utilised delivering endoscopy sessions rather than triage clinics. Alternative means of utilising the EDS need urgently considered, such as embedding the calculation of the EDS directly into the GP referral process to allow prioritisation at time of vetting. This will be the next focus of our service