Introduction

Close liaison with colleagues in surgery, radiology, pathology and oncology facilitates the treatment of different forms of GI disease and is essential for a high-quality service. Combined outpatient clinics (ie colorectal surgeon and gastroenterologist) undoubtedly improve management. Weekly timetabled cancer, IBD and liver multidisciplinary team (MDT) meetings are a useful forum for discussing patients with complex conditions. Meetings with radiologists and pathologists should take place at least once a week and can be combined with formal training sessions for trainees. Encouraging recruitment of talented trainees is also characteristic of a high-quality service.

Allowing sufficient time for staff development and appraisal to ensure that doctors are up to date and fit to practice and can be revalidated by the General Medical Council is also essential. Provision for staff development and training should be made in consultant job plans. The BSG has published guidance for this process for gastroenterologists. The endoscopy unit will fulfil the Joint Advisory Group (JAG) on Gastrointestinal Endoscopy’s requirements for endoscopy.

There are robust standards and key performance indicators for three major areas of gastrointestinal practice: endoscopy, IBD and liver disease.

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Endoscopy standards

Comprehensive quality standards are laid out by the Joint Advisory Group (JAG). It has developed and instituted an accreditation tool for endoscopy units which assesses units in four domains.

  1. Clinical quality and safety
  2. Quality of patient experience
  3. Workforce
  4. Training.

It also oversees training courses for endoscopists and endoscopy nurses. 

Along with the JAG standards for endoscopy services NICE has laid out standards for the management of acute upper gastrointestinal bleeding.

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Inflammatory bowel disease standards

Inflammatory bowel disease

The inflammatory bowel disease service should conform to the IBD Standards, NICE quality standard and participate in national clinical audit.

The IBD Standards have been summarised into six key standards. Audits of patient outcomes will be based on these standards.

  • Standard A – High-quality clinical care

High-quality, safe and integrated clinical care for IBD patients based on multidisciplinary team working and effective collaboration across NHS organisational structures and boundaries.

  • Standard B – Local delivery of care

Care for IBD patients that is delivered as locally as possible, but with rapid access to more specialised services when needed.

  • Standard C – Maintaining a patient-centred service

Patient-centred care should be responsive to individual needs and offer a choice of care strategies where possible and appropriate.

  • Standard D – Patient education and support

IBD care should empower patients to understand their condition and its management. This will allow them to achieve the best quality of life possible.

  • Standard E – Data, information technology and audit

An IBD service that uses data, IT and audit to support patient care effectively and to optimise clinical management.

  • Standard F – Evidence-based practice and research

A service that is knowledge-based and actively supports service improvement and clinical research. 

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Hepatology standards

Hepatology services should conform to standards set out in the Liver Quality Enhancement Service Tool (QuEST). Standards are organised into five domains:

  1. Leadership, organisation and delivery
  2. Clinical quality
  3. Patient experience
  4. Integrated care
  5. Workforce and training

Alcohol services should conform to standards laid out in the BSG’s position paper on alcohol-related disease.

These include:

  • a multidisciplinary consultant-led alcohol care team
  • a daily alcohol specialist nurse service
  • a mental health crisis team
  • an alcohol link workers network
  • a hospital-led multi-agency assertive outreach alcohol team:
  • person-centred and non-judgemental care
  • integrated alcohol treatment pathways between primary and secondary care.

In addition to the quality standards outlined above the BSG has published 55 clinical guidelines which define and specify a high-quality gastroenterology service.

The BSG has provided a list with links to NICE quality standards covering: the prevention of harmful alcohol use, IBD, hepatitis B, constipation in children and young people, faecal incontinence, acute upper gastrointestinal bleeding, nutrition support in adults, colorectal cancer and alcohol dependence. 

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