Coloproctology procedure clinic: a novel service developed to reduce suffering of patients with bleeding per rectum.
AIMS
Evaluation of the role and impact of introducing a dedicated coloproctology procedure clinic in tertiary referral colorectal unit.


METHODS
A retrospective analysis of 126 consecutive patients managed in the coloproctology clinic between March2015 and September 2016 was carried out. All patients were preselected for attendance based on symptom-based protocol.


RESULTS
Based on the information available in GP referrals, 126 patients with bleeding per rectum with low risk of cancer were re-triaged from the general outpatient to dedicated coloproctology procedure clinic. Those patients accounted for 14% of waiting list. The average waiting time to attend clinic was 27 months from referral to undergoing definitive procedure. A proctoscopy or/and rigid sigmoidoscopy was performed in patients. Seventy-nine (89.7%) patients were completely managed and discharged after attending their first visit. Sixty-seven (76%) patients had 2nd- or 3rd-degree haemorrhoids and were treated with rubber band ligation (RBL) or phenol injection in outpatient setting. Two patients had an anal fissure and were managed conservatively with medication. After clinic, follow-up was through telephone clinic. This avoids attendance physically in the hospital. Symptoms persisted in nine patients and were subsequently scheduled for colonoscopy, three had benign polyps. With the introduction of the procedure clinic, the waiting time from referral to treatment was reduced from 27 to 6 months (p < 0.05).


CONCLUSIONS
Establishing a dedicated "Coloproctology procedure clinic" is an effective strategy in reducing number of hospital visits per patient and hospital waiting list. This innovative clinic reduces utilisation of precious endoscopy unit resources. This ultimately will improve endoscopy efficiency.
['Bashir|Yasir|Y|http://orcid.org/0000-0001-8902-8883', 'McGovern|Bernadette|B|', 'Tahtouh|Mohammed|M|', 'Abbasi|Tahir|T|', 'Murphy|Maria|M|', 'Neary|Paul|P|']
D000328:Adult D005401:Fissure in Ano D006471:Gastrointestinal Hemorrhage D006484:Hemorrhoids D006801:Humans D010044:Outpatient Clinics, Hospital D018579:Patient Selection D012007:Rectum D012189:Retrospective Studies D012812:Sigmoidoscopy D061665:Time-to-Treatment D014850:Waiting Lists
Bleeding per rectum Haemorrhoids Rubber band ligation Colonoscopy Benign colorectal disease Colorectal cancer