Optimising endoscopy surveillance timing through automated vetting

Guy's and St Thomas' NHS Foundation Trust (GSTT) performs more than 20,000 endoscopies each year and the demand for this is increasing annually. The timing of surveillance endoscopy is often inaccurate as it relies on knowledge of up-to-date guidelines, as well as cross-referencing endoscopic and pathological findings over time, which has a high administrative burden.

Situation

GSTT needed to improve the scheduling of surveillance endoscopies to ensure they were necessary and timely, a situation which had been exacerbated by the COVID-19 pandemic as cancer-related activity was prioritised and other procedures postponed.

Aspiration

To implement a digital service that automates the decision about when a follow-up endoscopy should happen.

This would automate a time-intensive process that requires an appropriately qualified clinician. Using digital records would also improve quality and safety as all relevant cases would be identified and not missed.

Solution and impact

The endoscopy department at GSTT has been using the open source tool EndoMineR to automate performance metrics (such as aspects of the global rating scale) directly from free text reports since 2016.

GSTT extended the use of the framework to help decide on the timing of endoscopies.

The core functionality of the EndoMineR framework is designed to automate the process of cross-referencing endoscopic and pathological findings over time and compare them with up-to-date guidelines to ensure endoscopy timings are accurate.

The use of this type of technology has led to a significant reduction in administrative overhead when auditing the endoscopic service.

As an example, determination of the adenoma detection rate for individual endoscopists can take many hours to perform accurately through manual examination of reports. Using EndoMineR, these are instantly calculated for each endoscopist.

The metric is very accurate as it is derived directly from associated pathology reports rather than just the endoscopy report.

A cost saving analysis will be performed at the end of the initial 6-month pilot study (due to conclude in 2021).

Functionality

  • The tool accesses endoscopy and pathology text reports between a defined period.
  • The tool is accessible as a flexible framework or as a user interface served within the Trust.

Capabilities

The framework automates decision-making around the timing of surveillance endoscopies using endoscopy reports, natural language pathology and histopathology results.

The same framework allows automation of performance metrics, such as global rating scales, operational efficiency, and analysis of a number of endoscopy-specific outputs relating to specific gastroenterological diseases. This can be used to generate monthly personalised feedback reports containing performance metrics for individual endoscopists.

Scope

  • The tool is used in a clinical hospital setting

Find out more

Find out more about the aims of EndoMineR and how it works

A brief overview: EndoMineR for the extraction of endoscopic and associated pathology data from medical reports (PDF, 284 KB)

Key contact

Sebastian Zeki, Consultant gastroenterologist at St Thomas' Hospital in London

sebastian.zeki@gstt.nhs.uk