Find out more at www.alphalabs.co.uk/FIT 7 Reducing Colonoscopy Lists We are now getting real reductions in waiting times for colonoscopy in Tayside, with patients advancing through the system much faster. Without the FIT implementation I’m sure referrals would have continued to grow, but they have now plateaued and fallen for the first time in years. FIT Service Success Factors Referral pathways differ across the UK, so it’s important for any labs planning to set up a FIT service to fully understand their local procedures. It’s essential to engage with the gastro service. There may not always be a seamless communication system. I think you’ve got to adapt to whatever exists or take the opportunity to influence it. Labs have to understand the role of the GPs and you really need to know what your gastroenterologists want out of the testing. How are they going to use the test result, what turnaround time is appropriate and how many samples will there be? It’s important to look at how many referrals there are to gastro and how many colonoscopies are being done. Without that information you can’t really start to plan how the lab is going to offer the service. I think the key success factor for the Tayside implementation has been the team work between gastro and the labs. Flexibility and good communication on both sides has worked really well. We’ve also learned a lot from the GPs over time and adapted to providing more kits, as we initially underestimated that. Feedback to the GPs has been really crucial and we liaise every two or three months through a newsletter. We feedback regularly about what we’re actually funding, how many tests we’ve performed, how many referrals there have been etc. Support from the supplier of the test is also crucial because you need their offering to work with the local system, provision of instruction leaflets and help with the whole package. You need a logistics solution to get the tubes from the lab to the GP and back again in a time frame that suits the service. Labs shouldn’t underestimate the time taken to set this up. The next step for Tayside is really in refining the service, particularly regarding the detailing of the reports. We want to provide further guidance on what results mean to give GPs more confidence to make decisions. We are happy that our process is robust and just need to focus on further education of GP practices that haven’t yet engaged. We’re really interested to look at the population we have results from, to see if they are the demographic that is slow to engage with the GP. We’d also like to investigate sequential samples. If a patient has a negative FIT but still has symptoms, is it worth doing further tests? So there are lots of possibilities that we’ve not really explored yet. The team is hoping to publish the work to date by mid-2017. There’s an inevitable lag time in obtaining details of the clinical outcomes of these patients a lot of resource required to check on referral and clinical outcomes and this should not be underestimated. Reference 1. Mowat C, Digby J, Strachan JA, Wilson R, Carey FA, Fraser CG, Steele R. Faecal haemoglobin and faecal calprotectin as indicators of bowel disease in patients presenting to primary care with bowel symptoms. Gut. 2016 Sep; 65(9):1463-9 Judith Strachan (left) with Becky McCann, using the HM-JACKarc FIT System to analyse samples for faecal haemoglobin
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