Singer R, Campbell P, Fernandes C, Statham P, Hochhauser D, Bridgewater J
University College Hospital, 235 Euston Road, London, UK.
UCL Cancer Institute, London, UK.
BMC Cancer. 2017 May 25;17(1):365. doi: 10.1186/s12885-017-3335-0.
Patients with upper gastrointestinal malignancy often require admission to hospital with dysphagia or jaundice requiring therapeutic endoscopy. Endoscopic intervention is often effective permitting rapid discharge. An efficient service would permit rapid discharge for patients who are often at the end of life. We noted that a majority of patients in hospital under the gastroenterological oncology were admitted with symptoms requiring therapeutic endoscopy.
We conducted an audit cycle of the inpatient days before and after pathway implementation. A wait of 1 day was set as acceptable for patients with bleeding as defined by NICE guidance and we set an arbitrary standard of 2 days for patients without bleeding but requiring therapeutic endoscopy. Between the audit cycles, a pathway was built to accommodate these patients.
Inpatient waits improved from a median of 3 days to 1 day. There was no difference in outcome between those presenting with bleeding and other symptoms or any difference in patients requiring different procedures.
Waiting times for endoscopy can be improved with the introduction of a targeted pathway of cancer patients. Further issues including cost, quality of life and nutrition require further intervention.
上消化道恶性肿瘤患者常因吞咽困难或黄疸需接受治疗性内镜检查而住院。内镜干预通常有效，可使患者迅速出院。高效的服务应能让这些常处于生命末期的患者快速出院。我们注意到，胃肠肿瘤学领域住院的大多数患者因需要治疗性内镜检查的症状而入院。
我们对路径实施前后的住院天数进行了审核周期。按照英国国家卫生与临床优化研究所（NICE）指南的定义，将出血患者等待1天视为可接受，对于无出血但需要治疗性内镜检查的患者，我们设定了2天的任意标准。在审核周期之间，建立了一条路径来接纳这些患者。
住院等待时间从中位数3天改善到了1天。出血患者与其他症状患者的结局无差异，不同手术患者之间也无差异。
引入针对癌症患者的目标路径可改善内镜检查的等待时间。包括成本、生活质量和营养在内的其他问题需要进一步干预。
