Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2025
Summary
Project ATEA (Accelerated Triage for Endoscopy Access) was developed to facilitate rapid access to endoscopy services and bypass long clinic wait times for high risk, low complexity gastroenterology referrals from the community to the Logan Hospital.
Implementation sites: Logan Hospital
Dates: December 2024 -
Partnerships: N/A
This project was presented as a Poster at CEQ Showcase 2025 (PDF 241KB).
Aim
The overarching goal of project ATEA was to rapidly identify high risk patients referred from the community who could be safely fast-tracked to receiving diagnostic endoscopy.
Outcomes
Project ATEA utilised a highly protocolised nurse-led triage process developed following multiple stakeholder consultation to address two major bottlenecks identified in the patient journey from referral to definitive care;
1. wait time from referral to triage
2. wait time from triage to clinic.
An audit following initial implementation of this project found that dedicated nurse-led triage through project ATEA could process 78% of community gastroenterology referrals without need for medical involvement. Additionally, 56% of referrals could be safely fast-tracked to direct access endoscopy, bypassing clinic wait times and resulting in more expeditious care for patients.
Background
LBHS received, on average, 180 Gastroenterology referrals per week for the year 2024. This volume of work placed a significant strain on a limited medical workforce, resulting in triage times greater than the key performance target of five days. Additionally, the need for review in clinic for these referrals also added to clinic wait times and further delay. It was recognised that delay in care, particularly in patients referred for diagnostic endoscopy with high-risk indications, could result in delayed diagnosis of cancers. Potential progression of disease while waiting could result in poorer patient outcomes. The existing pathway of patient care required the patient to be triaged by a medical officer, reviewed in either a medical or nursing clinic, and finally added to the endoscopy wait list. Wait times to being triaged and wait times to being seen in clinic were identified as being significant bottlenecks that needed to be addressed. Potential avoidable clinic reviews also diverted resources away from other higher acuity patients.
Methods
Work was started to identify alternative care pathways that could be utilised to overcome the above bottlenecks, this included leveraging the full potential of the multidisciplinary team, upskilling our existing nursing staff, and co-ordinating with multiple stakeholders including gastroenterologists and anaesthetists.
Several key objectives were identified to enable more efficient and timelier workflow:
- Diversification of triage responsibilities to include both nursing and medical staff
- Development of Gastroenterology specific criteria to enable protocol driven nurse triage direct to endoscopy for appropriate high-risk patients a. This had to include the selection of appropriate investigative procedure (gastroscopy or colonoscopy) and categorisation (4, 5, or 6) which extended beyond the Clinical Prioritisation Criteria (CPC)
- Development of robust criteria for patients suitable for direct access endoscopy in collaboration with the anaesthetic department both at our own hospital but also our associated regional hospital in Beaudesert 4. A process for automatic redirection of referrals to the most appropriate
hospital wait list based on geographic location and service capacity (Logan Hospital vs Beaudesert Hospital) Following extensive consultation and review, the ATEA project was developed.
The project introduced an alternative care pathway which included the following steps:
- Rapid first pass nurse-led triage of all Gastroenterology referrals received from the community
- All referrals are assessed against a set criterion for high-risk indications warranting endoscopic investigations with the most suitable
modality and category selected - Any referral outside of the set criterion is left for triage by a medical officer
- Selected referrals are then assessed against the following direct access exclusion criteria:
- Age greater than 80
- Recent relevant procedure (gastroscopy or colonoscopy) within the last 2 years
- Substantive functional or cognitive limitations
- Moderate to severe COPD (Chronic Obstructive Pulmonary Disease)
- Moderate to severe heart failure
- End Stage Renal Disease
- Patients on dialysis
- Morbid obesity (BMI greater than or equal to 45)
- Recent (less than 12 months) myocardial infarct, cerebrovascular accident, thrombus, or insertion of vascular stent
- Pregnancy
- Referrals meeting exclusion criteria are redirected to clinic for review
- Referrals suitable for direct access are redirected to the appropriate facility endoscopy wait list based on geographic post code and service capacity Strict governance protocols were enacted including the need for non-nurse practitioner credentialing prior to nurse triage utilising project ATEA criteria. The project also required weekly governance meetings between the Endoscopy Access (EA) Clinical Nurse Consultant (CNC) performing triage and the Deputy Director of Gastroenterology. Ongoing feedback loops with all stakeholders resulted in refinement of both selection and exclusion criteria as the project progressed.
Discussion
Several challenges had to be overcome during implementation. While clinical prioritisation criteria exist for triage to clinic, ATEA criteria needed to go further and determine potential subsequent investigation and category based on information available in the referral. This required extensive discussion and consensus amongst Gastroenterologists working at the local site to determine the most appropriate and safe criterion to use. A primary focus of the project was to ensure patient safety and minimise unnecessary endoscopic investigation. Diversion to direct access was reserved for the highest risk indications. Consequently, insufficient data or unclear symptoms and signs in referrals continue to present challenges, necessitating clinic reviews in numerous cases.
Given the effectiveness in the initial pilot period, we aim to expand the project further by allocating more time and resources to nurse-led triage utilising the project ATEA pathway. This pathway could potentially be expanded for utilisation at a health service level. A centralised rapid nurse triage process could be established for all of Metro South Health based on consensus around selection and exclusion criteria from all hospitals in the network. Once procedure and category has been assigned to the referrals, they can be distributed to any hospital in the network based on patient geography, or even hospital capacity, to allow for more dynamic load balancing. The establishment of standard criteria and pathways as part of project ATEA could also lay the groundwork for future rapid first pass triage by artificial intelligence (AI) models, further reducing workload and increasing efficiency.
References
N/A
Key contact
Sherilyn Yates
Clinical Nurse Consultant
Metro South Hospital and Health Service