HIQA has today published recommended referral and treatment thresholds for patients who may require common pre-planned (scheduled) gastrointestinal (GI) procedures.

The recommendations are aimed at identifying those people who stand to benefit most from each procedure assessed. Dr Máirín Ryan, Director of Health Technology Assessment in HIQA, said: “We are emphasising that the referral criteria are designed to distinguish between patients who would gain additional benefit from investigation or surgery over management by their family doctors. The developed thresholds identify ‘red flag’ signs and symptoms, suggestive of, for example, cancer, and provide guidance regarding urgency of referral for these patients to secondary care.”

This latest phase in a series of health technology assessments focuses on referral thresholds for patients with upper and lower gastrointestinal (GI) symptoms who may require further review including upper GI endoscopy (otherwise known as gastro-oesophago-duodenoscopy, OGD) or lower GI endoscopy (colonoscopy or sigmoidoscopy) to rule out malignancy. Referral thresholds for those who may require gallbladder removal, groin hernia repair or surgical intervention for haemorrhoids are also included.

HIQA’s Director of Health Technology Assessment Dr Máirín Ryan said: “Despite significant increased activity by general surgery and gastrointestinal services over recent years, demand continues to exceed resource availability, with consequent pressure on waiting lists. It is in this context that these HTAs aim to ensure that the right patients receive referral and treatment at the right time and, in particular, that unnecessary referral is avoided in those people who are unlikely to get additional benefit from intervention over other treatment options.”

The number of elective colonoscopies or sigmoidoscopies provided by the publicly-funded health service increased by 67.2% from 39,936 in 2005, to 66,760 in 2012, while the number of elective upper GI endoscopies increased by 44% from 41,803 to 60,038, in the same timeframe. The HSE has set a target that no patient should wait for more than four weeks for an urgent endoscopy from the time of referral, and they are also monitoring the number of people waiting longer than 13 weeks. HSE National Performance Assurance reports state that they are meeting this target for urgent colonoscopy with all referrals seen within four weeks. However, substantial increases in demand are placing increasing pressure on the Irish healthcare service, with demand for both outpatient appointments and scheduled surgical and endoscopic procedures continuing to exceed available capacity.

Dr Ryan continued: “These referral thresholds aim to provide general practitioners, surgeons and other clinicians involved in the care of these patients with a template upon which decision-making can be standardised. Based on projections from the National Cancer Registry in Ireland, the absolute number of people diagnosed with upper and lower GI cancer is expected to continue to increase. The thresholds for upper and lower GI endoscopy aim to ensure that all patients with symptoms suggestive of underlying malignancy are seen urgently, while simultaneously aiming to avoid unnecessary referral and investigation of patients who can be best managed in the primary care setting.”

These are the latest in a series of reports making recommendations on scheduled procedures and they were developed following an extensive review of international best practice, consultation with an expert panel, and a public consultation by HIQA. The completed reports have been submitted to the HSE and to the Minister for Health.

ENDS

Further Information: 

Please contact: Marty Whelan, Head of Communications and Stakeholder Engagement

01 814 7480 / 086 2447 623 mwhelan@hiqa.ie

Notes to the Editor: 

• HIQA is the statutory organisation in Ireland with a responsibility to carry out national health technology assessments (HTAs) and to develop guidelines for the conduct of HTAs across our healthcare system.
• Phase IV of this series of HTAs include:
  • Referral thresholds for patients with lower GI symptoms suspected of indicating malignancy
  • Referral thresholds for patients with upper GI symptoms suspected of indicating malignancy
  • Referral thresholds for adult patients with groin (inguinal or femoral) hernia
  • Referral thresholds for adult patients suspected of having gallstone disease
  • Referral thresholds for haemorrhoid procedures.
• Supporting documents include the ‘Background and Methods – Phase IV’ and ‘Ethical Analysis’ documents.
• Upper GI endoscopy, otherwise known as a gastro-oesophago-duodenoscopy (OGD), involves the passage of a flexible fibre-optic endoscope through the mouth, throat, oesophagus, stomach, and duodenum, and is generally performed as a day case under sedation or with topical anaesthesia to the oropharynx.
• Colonoscopy involves fibre-optic examination of the entire large bowel, and is generally performed as a day case under sedation. Sigmoidoscopy involves limited fibre-optic examination of the large bowel, and is also generally performed as a day case.
• The number of elective lower GI endoscopies (colonoscopy or sigmoidoscopy) undertaken in the publicly-funded healthcare system increased by 67.2% from 39,936 in 2005 to 66,760 in 2012.
• The number of elective upper GI endoscopies undertaken in the publicly-funded healthcare system increased by 44% from 41,803 in 2005 to 60,038 in 2012.
• At the end of July 2014, it was reported that there were 360,753 patients on the Outpatient Waiting List database (includes all medical and surgical outpatients) collated by the National Treatment Purchase Fund (NTPF), 34.7% of whom were waiting longer than six months, with 10.5% on the list for longer than 12 months.