Reducing Wait Times for Routine Surveillance Colonoscopies Post-Polypectomy.

Long waiting times are a national and international healthcare concern that affects the majority of hospital services, including Ireland. Due to the COVID-19 pandemic, the waiting times for gastroenterology scopes in Ireland increased by 59%. By the end of February 2021, 36,820 patients were on endoscopy waiting lists. Long wait times for routine surveillance colonoscopies post-polypectomy specifically can result in a missed pathology of colorectal cancer. In the project site, patients are given recommended screening dates post-polypectomy, based on their clinical and histological findings. The patients at the project site are currently waiting for their surveillance colonoscopies to be scheduled up to two years after the recommended date. Using Lean Six Sigma tools and the DMAIC (Define, Measure, Analyse, Improve and Control) model the cause of these lengthy waiting times were identified. One root cause found was the non-adherence to the updated 2020 version of ‘The Association of Coloproctology of Great Britain and Ireland(ACPGBI) Surveillance Guidelines Post-Polypectomy.’ Clinician referrals were analysed alongside patient’s clinical and histological findings. The recommended date of surveillance according to the clinician was compared to the recommended date of surveillance according to the ACPGBI guidelines. The results showed 273 referrals within the project site did not adhere to the updated guidelines. The proposed plan includes the implementation of education sessions on the ACPGBI Surveillance Guidelines and the proposal to have a dedicated healthcare professional monitoring the adherence to the guidelines. Expected outcomes include the decrease of routine surveillance waiting lists within the endoscopy service by 69%, effective immediately.