Neurogastroenterology Unit, Manchester University NHS Foundation Trust, Manchester, UK.
Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK.
BMJ Open Gastroenterol. 2021 Dec;8(1). doi: 10.1136/bmjgast-2021-000810.
The COVID-19 pandemic significantly impacted on the provision of oesophageal physiology investigations. During the recovery phase, triaging tools were empirically recommended by national bodies for prioritisation of referrals amidst rising waiting lists and reduced capacity. We evaluated the performance of an enhanced triage process (ETP) consisting of telephone triage combined with the hierarchical 'traffic light system' recommended in the UK for prioritising oesophageal physiology referrals.
In a cross-sectional study of patients referred for oesophageal physiology studies at a tertiary centre, data were compared between patients who underwent oesophageal physiology studies 6 months prior to the COVID-19 pandemic and those who were investigated within 6 months after service resumption with implementation of the ETP.
Adjusted time from referral to investigation; non-attendance rates; the detection of Chicago Classification (CC) oesophageal motility disorders on oesophageal manometry and severity of acid reflux on 24 hours pH/impedance monitoring.
Following service resumption, the ETP reduced non-attendance rates from 9.1% to 2.8% (p=0.021). Use of the 'traffic light system' identified a higher proportion of patients with CC oesophageal motility disorders in the 'amber' and 'red' triage categories, compared with the 'green' category (p=0.011). ETP also reduced the time to test for those who were subsequently found to have a major CC oesophageal motility diagnosis compared with those with minor CC disorders and normal motility (p=0.004). The ETP did not affect the yield or timing of acid reflux studies.
ETPs can effectively prioritise patients with oesophageal motility disorders and may therefore have a role beyond the current pandemic.
COVID-19 大流行对食管生理检查的开展产生了重大影响。在恢复期，国家机构根据经验推荐了分诊工具，以便在等待名单增加和能力下降的情况下对转诊进行优先排序。我们评估了增强分诊流程（ETP）的性能，该流程包括电话分诊以及英国推荐的用于食管生理转诊的分层“红绿灯系统”。
在对一家三级中心进行食管生理检查的患者的横断面研究中，我们将在 COVID-19 大流行前 6 个月接受食管生理检查的患者的数据与在服务恢复后 6 个月内接受检查的患者的数据进行了比较，后者实施了 ETP。
实施 ETP 后，从转诊到检查的调整时间、未就诊率、食管测压时芝加哥分类（CC）食管动力障碍的检出率以及 24 小时 pH/阻抗监测时酸反流的严重程度均得到了改善。
ETP 可以有效地对食管动力障碍患者进行优先排序，因此除了目前的大流行之外，可能还有其他作用。
