From the origin of THRIVE a core goal has been to improve Endoscopy practices without causing significant disruption or requiring any extra staff or funding. THRIVE’s purpose is to simply collect data, reveal trends and allow hospitals to increase efficiency through using the people, rooms, and equipment they already have.
What the OGD data has revealed…
Following a study performed by The Innovation Agency in 2022 we began to understand that we now have enough information to make data driven conclusions that may improve productivity and help to reduce the strain currently placed on the NHS. We have been able to study the interaction between Oesophago-gastro-duodenoscopies (OGDs) and cancellation rates.
Over the course of a period of 12 months we have collected a dataset containing 150,000 procedures over the vast majority of the North-West giving us valuable insight into the reality of what’s actually occurring in Endoscopy units. From this we’ve been gaining a much deeper understanding of what can be done to get more patients treated every day.
Did Not Attend
Using the 150,000 procedure dataset recorded on the THRIVE system from the 1st of May 2022 to the 1st of May 2023 we can state the following about the highest Did Not Attend (DNA) rates by procedure:
| Procedure Type (*Procedures with more than 250 performed) | DNA Rate per Procedure % | DNA’s | Completed + Cancelled Procedures |
| Oesophago-gastro-duodenoscopy (OGD) | 7.63% | 4014 | 52635 |
| Oesophago-gastro-duodenoscopy (OGD) + Flexible Sigmoidoscopy | 7.06% | 58 | 821 |
| EUS Liner | 6.77% | 58 | 857 |
| Cystoscopy | 6.41% | 124 | 1933 |
| Oesophago-gastro-duodenoscopy (OGD) + Colonoscopy | 5.62% | 440 | 7830 |
Of the 25 procedure types and procedure combinations currently on THRIVE, procedures containing an OGD made up 3 of the top 5 highest DNA rates and 4 of the top 8 highest DNA rates in procedures where over 250 have been performed.
Failing to fast
Furthermore, when looking at the percentage of patients per procedure type that had to cancel due to the patient failing to fast, we get the following 5 highest cancellation rates:
| Procedure Type (*Procedures with more than 250 performed) | Patient Failed to Fast Rate % | Patients Failed to Fast | Completed + Cancelled Procedures |
| Oesophago-gastro-duodenoscopy (OGD) | 0.72% | 378 | 52635 |
| Bronchoscopy | 0.67% | 8 | 1186 |
| Oesophago-gastro-duodenoscopy (Therapeutic) | 0.65% | 62 | 9565 |
| Oesophago-gastro-duodenoscopy (OGD) + Flexible Sigmoidoscopy | 0.49% | 4 | 821 |
| ERCP | 0.43% | 10 | 2314 |
OGD’s, and procedures containing an OGD, make up the majority of these cancellations by percentage. Now viewing similar figures for procedures cancelled due to the patient not being prepared we get:
| Procedure Type (*Procedures with more than 250 performed) | Patient Not Prepared Rate % | Patients Not Prepared | Completed + Cancelled Procedures |
| EUS + Oesophago-gastro-duodenoscopy (OGD) | 1.71% | 6 | 351 |
| EUS Liner | 1.28% | 11 | 857 |
| ERCP | 0.95% | 22 | 2314 |
| Oesophago-gastro-duodenoscopy (OGD) + Colonoscopy | 0.93% | 73 | 7830 |
| Colonoscopy | 0.93% | 388 | 41724 |
From these three tables we can see there appears to be a cancellation concern with patients when it comes to OGD’s. This could suggest that the way in which patients are informed about the preparation they are required to complete in advance of an OGD procedure could be in need of review and that lists where OGD’s are planned should take extra consideration with regard to the impact of known cancellation reasons and take actions accordingly.
Given the short nature of actually completing an OGD and the reduced preparation required by the patient in advance (a Colonoscopy requires 48 hours of prep), these procedures can be added into lists at short notice far more easily than some more complex and time-consuming procedures. At sites that perform ‘OGD only’ lists – at 1 point per procedure – these lists can confidently be overplanned as statistically at least one patient will either not attend or have the procedure cancelled. Similarly, in trusts with multiple rooms, if a single list is overplanned by a single OGD per 4 hour session, with the assumption that one procedure within one of the multiple lists running is cancelled, then Endoscopy units (and this is only those currently using THRIVE) would be able to see over 400 extra patients per year (assuming 200 working days per year and 2 sessions per day).
Alternatively, there is scope to look at reducing the number of OGDs that go unperformed. Currently there is a combined total of 15.54% of all OGDs cancelled. Of those cancellations nearly half consist of DNA’s. If that figure was reduced by just 5%, resulting in a 10% cancellation rate, there would statistically be a realistic opportunity to be able to perform over 4000 more OGD’s per year in the North West alone.
According to NHS Statistics within Endoscopy as of May 2023 37.6% of all patients were waiting longer than 6 weeks to be seen for a diagnostic test. While these waiting lists are not driven by OGD’s in particular, being able to perform 4000 more OGD’s at no expense to already planned lists would free up thousands of hours for other tests with longer backlogs.
This is one of our first articles really digging into the statistical implications of THRIVE data collection and was compiled by our THRIVE lead Callum Headley.
