Authors (including presenting author) :
Lam CP (1), Choy YK (1), Ng YHG (1), Liu LW (1), Ng SMS (2), Ho PYB (3), Chui ST (1)
Affiliation :
(1) Department of Surgery, Prince of Wales Hospital; (2) Colorectal Surgery, The CUHK University; (3) Central Nursing Division, Prince of Wales Hospital
Introduction :
Colorectal patient service always be a focus in management because of its high-volume and great service demands in Hospital Authority. Different strategies were implemented in order to shorten the waiting time of consultation and early diagnosis. An Integrated Model of Specialist Outpatient Service through Surgical Nurse Clinic (Colorectal Care) was developed in Prince of Wales Hospital since Oct 2020. The service model was a one-stop shop healthcare: cancer and non-cancer service were all covered.
Objectives :
1.To have early cancer detection 2.To reduce pressure on Colorectal SOPC and shorten the waiting time for new case consultation 3.To expand the nursing service on bowel dysfunction
Methodology :
The service model included three clinical pathways, they were, Triage lower GI symptoms bundle, Bowel function care and Cancer survivorship. First, Triage lower GI symptoms bundle - new referrals for patient with rectal bleeding or altered bowel habit would see the specialty nurse for triage, early colonoscopy would be arranged for suspicious cancer cases. Second, Bowel function care – nurse performed anorectal assessment and provided tailor-made nursing interventions such as behavior modification, transanal irrigation and biofeedback to patients with bowel dysfunction. Third, Cancer survivorship – 5 years survivors were transitioned to the nurse clinic for long term follow up. Each pathway has its own clinics and protocols, the patient outcomes from Oct 2020 to September 2022 (two years of service) were evaluated.
Result & Outcome :
First, the Triage lower GI symptoms bundle - total 1131 new cases referral were recruited. The waiting time from referral to the first consultation was shortened from 18 months to 6.6 months. 18% of cases with red flag symptoms needed early colonoscopy arrangement. 9% was confirmed with colorectal cancer. Second, the Bowel function care - recruited patients mainly with three types of bowel problems, they were, faecal incontinence (FI), constipation and low anterior resection syndrome (LARS). Total 462 new cases attended the functional clinic. Symptoms improvement and international score were used for outcomes measures. Both FI and constipation groups had over 75% symptoms improvement and LARS group with score 24 to 13 after treatment completed. At last, Cancer survivorship - 1238 survivors were transitioned. It saved over 50 doctor sessions per year. 6% cases referred back to doctor clinic for suspicious symptoms and 8% of them finally confirmed CRC recurrence or new cancer. To conclude, the service model has provided an effective and comprehensive care across the specialty.
