Professional Documents
Culture Documents
Scoping Our Practice: The 2004 Report of The National Confidential Enquiry Into Patient Outcome and Death
Scoping Our Practice: The 2004 Report of The National Confidential Enquiry Into Patient Outcome and Death
Scoping Our Practice: The 2004 Report of The National Confidential Enquiry Into Patient Outcome and Death
Practice
Experience
• 74% of procedures performed by
consultants, some doing less than
20/ year
• 94% appropriate grade
• 91% appropriate experience
Training and education
Supervision
• 88% - senior endoscopist in hospital
• 18% - direct supervision
Audit
• 78% of procedures in hospitals that
held audit meetings
• 26% of cases reviewed
Recommendations
Indication
• Neurological disorders of swallowing
• Cognitive impairment/depressed
consciousness
• Mechanical obstruction to swallowing
• Long-term partial failure of intestinal
function requiring supplemental intake
PEG
Profile
• In 59% of cases the indication included
acute neurological disease
(stroke/trauma)
• 82% were 70 years of age
• 84% were ASA 3 or poorer
• 95% were elective/scheduled
procedures
PEG
Patient selection and timing
• 19% of PEG procedures were thought
to be futile
• 40% had a co-existing diagnosis of
chest infection
• 18% had dementia
• 43% died within 7 days
In one case where a patient was over 90
years-of-age an advisor commented:
Profile
• 82% 70 years of age
• 77% were ASA 3 or poorer
• 87% received prophylactic antibiotics
• 68% were considered futile
ERCP
Procedure
• 97% performed by consultants
• 11% of cases by endoscopist who
performed < 50 ERCPs/year
• 92% involved the biliary tract
ERCP
Complications
• In 9% of cases during the procedure
• 64% of patients had one or more
complications in the 30 days following
ERCP
Recommendation
Profile
• 44% of sample cases
• 61% 70 years of age
• 44% bleeding varices
• 35% stricturing disease in oesophagus
• 20% ulcer disease
OGD
Treatment
• sclerotherapy, coagulation, banding
Complications
• haemorrhage, respiratory and cardiac
Upper GI haemorrhage
Upper GI haemorrhage