ISTCs offer endoscopy best practice

Dr Eva Vincze, Ph D, Consultant Gastroenterologist, Ramsay Health Care


Endoscopy procedures have become routine, but high demand initially meant long waiting lists. Part of the solution has come from independent sector treatment centres (ISTCs), which are purpose-designed for rapid access.

Ramsay Health Care, a leading independent healthcare provider, has 11 ISTCs providing NHS care in England. Gastrointestinal endoscopy services have been developing steadily since Ramsay’s first ISTC opened to patients in 2005. Thousands of upper and lower endoscopies have now been performed in our treatment centres, which are equipped with new instrumentation and modern decontamination facilities.


Efficacy in endoscopy means more than performing large numbers of procedures. Quality and patient safety are our major focus. Our waiting time is not longer than two weeks from receiving a GP referral - and can be as short as one to two days because, as small units, we can manage cases individually. We follow a strict pre-assessment process, including a thorough medical assessment for all patients with high risk of complications. We have collected quality assurance data since inception of the service, and a recently installed electronic reporting system will ensure access to accurate figures as required. All our endoscopy centres have joined the GRS (Global Rating Scale) electronic quality assurance assessment tool, and achieved high grades on the system. In recognition of our data, some of our units were asked to participate in adaptation of this scale for day case endoscopy practice.


A presentation on colonoscopy data in four Ramsay treatment centres during a 12 month period was recently accepted by a regional British and European Gastro Congress. Analysis of 1,072 colonoscopies demonstrated the caecal intubation rate was 94.9% and the adenoma detection rate 24.5%. Doses of sedation were within the guidelines of the British Society of Gastroenterology. We also record patient comfort and satisfaction levels, reaching 100% satisfaction in all our units.


Currently our endoscopy units are involved in a process of JAG (Joint Advisory Group) accreditation. Boston NHS Treatment Centre, in Lincolnshire, was the first of our units to successfully complete the process. All of Ramsay’s other ISTCs have made encouraging progress and will hopefully achieve full accreditation in the near future.


High quality, JAG-accredited training has been undertaken in our Bodmin and Cobalt (Newcastle) NHS Treatment Centres in the past two years. Prominent representatives of JAG were involved. These were excellent occasions for developing our practical skills and guidelines, and to share ideas on the role of ISTC endoscopy. ISTC endoscopists have since been given exciting opportunities to participate in British and international gastrointestinal congresses.


Reflecting the quality and safety of our practice, we are receiving a growing amount of positive feedback from GPs, and even from our local ‘competitor’ hospitals.


The first few years of ISTC practice have provided growing evidence of the quality and safety profile in day case endoscopy. In the future, ISTCs may develop as key providers of diagnostic procedures, giving inpatient facilities more capacity to focus on emergency cases and therapeutic endoscopy. Having been JAG accredited, ISTC endoscopists would also welcome the opportunity to participate in the national bowel cancer screening program.

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