One in 20 colonoscopies do not go ahead as planned due to poor or insufficient prep. King’s College Hospital’s Mayur Kumar explains how his trust worked with Healthcare Communications to reduce cancellations by 28 per cent, saving £336,000 a year.
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The majority of colorectal cancers are diagnosed through colonoscopies, meaning it’s an incredibly important and life-saving tool which is used to diagnose and treat many colonic conditions. It’s critical the resource is used as efficiently and time-sensitively as possible to deliver effective patient care and meet the NHS long-term plan and cancer waiting list targets.
Across the UK, 5 per cent of colonoscopy procedures do not go ahead as planned because patients forget to take their bowel prep, or incorrectly follow pre-procedure bowel prep instructions. Every year, the NHS carries out more than one million colonoscopies, equating to 50,000 wasted appointments.
Patient anxiety about colonoscopy procedures significantly contributes to poor preparation which compromises the quality of the procedure, extending its duration and potentially leading to adverse outcomes and missed lesions. The situation is exacerbated by an ongoing national shortage of colonoscopy resources and overall capacity due to the elective backlog from covid-19 and subsequent slow recovery.
An inefficient colonoscopy service has significant financial implications. The NHS colonoscopy appointment tariff is £372, which means each slot that cannot go ahead is a loss of income for a trust. King’s College Hospital Foundation Trust carries out around 8,500 procedures annually. With an appointment failure due to poor bowel prep ranging between 6-7 per cent, equating to around 1,300 appointments, this leads to a financial loss of roughly £221,000 a year.
Overcoming challenges with digital innovation
To address the adverse effects on patient care and services, we collaborated with Barking, Havering and Redbridge University Hospitals Trust and applied for NHS Digital funding to develop an innovative digital solution.
With the funding successfully awarded, we partnered with Healthcare Communications to implement digital pre-procedure support for patients. A series of automated text messages was established with repetitive messaging to encourage accurate compliance, scheduled based on the time of the patient’s appointment. Beginning with a standard reminder 14 days before, four more SMS messages contain links to instructional videos and prompts at the exact times for fasting and bowel preparation.
KCH serves a diverse population, so inclusivity was a crucial consideration. We carried out surveys to ensure all demographics were happy to receive digital communications, with 83 per cent agreeing from all age groups. For those who do not have or feel comfortable using a smartphone, we made provisions to offer paper appointment letters and instructions sent via post.
In the six months following our implementation, the solution proved highly effective, reducing colonoscopy cancellations by 28 per cent, from 6.27 per cent to 4.49 per cent.
By minimising the number of wasted appointment slots we’ve streamlined the appointment process and have been able to save approximately £336,000 annually.
KCH’s Boston Bowel Prep Scores increased from an average of 5.82 to 6.82, indicating a 20 per cent quality improvement in diagnostic accuracy and patient outcomes. Post-implementation we had set out to achieve a score between six and seven which is deemed highly favourable.
Getting it right first time
The initiative has promoted sustainability within the healthcare system by diminishing the necessity for repeat procedures, thereby reducing the wastage of medical resources. This was complemented by the freed-up staff time and increased capacity to tackle patient backlogs. Consequently, the enhanced efficiency led to improved turnaround times for urgent and routine referrals and is reflected in our diagnostics waiting times and activity data.
Colonoscopy is an invasive procedure, and the bowel prep process is very unpleasant for patients. Helping to ensure patients don’t have to go through it more than once is vital for a good patient experience.
In one month, 98 per cent of patients accessed the bowel prep information. In the same month, more than 85 per cent reported that they found the text message reminder helpful in preparation for their colonoscopy.
We found working with the Healthcare Communications team very useful and their digital innovation solutions are user-friendly, which made us achieve our project goal easily. The organisation is highly experienced in providing digital solutions for NHS services and is a great team to work with.
The model has become a smooth routine process that is effectively embedded into our service. The premise of the funding was to demonstrate benefits so the solution could be rolled out further across all London NHS endoscopy services. When the benefits are being realised pan-London we intend to extend the roll-out nationally.
As a project team, we are eager to share key learnings and fulfil our future objectives. The prospect of scaling the initiative nationally will significantly improve patient care and unlock efficiency and financial savings. Collectively they will inject a much-needed productivity boost to support the ongoing efforts to reduce the burden on the NHS.
