Transcript (Draft) Pathway for Direct Access Flexible Sigmoidoscopy

Direct Access Flexible Sigmoidoscopy Pathway for GPs
Patients 50+
Rapid Access Proctology Clinic
16-50
LGI 1 Rectal bleeding with or without anal symptoms and
no change in bowel habit for 6 weeks or more
LGI 2 Rectal bleeding with change in bowel habit
(increased frequency/increased looseness) for 6 weeks or
more
LGI 3 Change in bowel habit for 6 weeks or more
(increased frequency/increased looseness) without rectal
bleeding
LGI 4 Palpable rectal mass
LGI 5 Right lower abdominal mass consistent with
involvement of the large bowel
LGI 6 Unexplained iron deficiency anaemia
Men HB< 11g/dl
Post menopausal women < 10g/dl
Patient arrives at the Unit with a referral
letter from GP
2 Week Rule Colorectal Clinic
LGI 1 Rectal bleeding with or without anal
symptoms and no change in bowel habit for 6
weeks or more
LGI 2 Rectal bleeding with change in bowel habit
(increased frequency/increased looseness) for 6
weeks or more
LGI 3 Change in bowel habit for 6 weeks or
more (increased frequency/increased
looseness) without rectal bleeding
LGI 5 Right lower abdominal mass consistent
with involvement of the large bowel
LGI 6 Unexplained iron deficiency anaemia
Men HB< 11g/dl
Post menopausal women < 10g/dl
Patients of any age
LGI 4 Palpable rectal mass
Referral to:
St George’s Healthcare NHS Trust
Fax Number: 020 8725 0778
Tel Number: 020 8725 1111
[email protected]
Complete referral form and fax to
St George’s Healthcare NHS Trust within 24
hours
Fax Number: 020 8725 0778
Tel Number: 020 8725 1111
[email protected]
Provide Patient Information and Consent Form
Issue an enema prescription
Assess patient for self-administration. If inappropriate, Endoscopy
Unit will arrange District Nurse visit to administer to patient
• Hospital to contact patient by phone to arrange appointment
• Hospital arranges home enema with District Nurse (if required)
• Endoscopy appointment booked
• Confirmation sent to patient and GP
• Transport/interpreter arranged (if required)
Enema at home
Patient attends endoscopy appointment
Pre-assessment with nurse endoscopist
Flexible sigmoidoscopy
Cancer Suspected
Enter colorectal pathway
Further investigations
Discuss at colorectal
MDT
DNA
discharge back to GP
Polyp detected
Adenoma
Hyperplastic
Book
Colonoscopy
Letter to GP within 5
days with outcome of
consultation
Letter to GP within 5 days
with outcome of
consultation
EXCLUSIONS FROM THE DIRECT ACCESS SIGMOIDOSCOPY PATHWAY
Patients with constipation
Unexplained iron deficiency anaemia
Lower abdominal mass
Significant co-morbidities (respiratory, cardiac, renal or neurological)
Patients who have had an endoscopic investigation (colonoscopy/flexible
sigmoidoscopy) within the last 2 years
Cancer not suspected
Discharge back to GP
If referral to other speciality is
indicated, follow current Trust
policy
Advice and/or treatment may
be offered for haemorrhoids or
minor conditions
Letter to GP within 5 days
with outcome of
consultation
Patients without mental capacity to consent
Patients who are already under investigation for suspected cancer
Patients with existing inflammatory bowel disease
Patients with known infective diarrhoea
Patients who will require an overnight stay