Your unit has a backlog of 900 overdue surveillance colonoscopies and the waiting list is growing. You have been asked to lead a response. How would you approach it?

Question

You are the gastroenterology registrar. Post-pandemic recovery has stalled, two endoscopists have left, and the trust has asked for a plan within four weeks. The backlog includes post-polypectomy surveillance, IBD surveillance and Lynch syndrome patients.

Accepted Answer

My first action would be clinical rather than managerial. Nine hundred patients on a surveillance list do not carry equal risk, so I would risk-stratify: Lynch syndrome and other hereditary syndromes, high-risk post-polypectomy findings and long-standing extensive colitis come out first and get booked, while low-risk surveillance can safely wait longer. That protects patients this week without needing a single extra slot. Second, I would validate the list, because legacy backlogs are always smaller than they look — patients will have died, moved, been scoped privately or elsewhere, or no longer meet the criteria. Third, and this is usually the biggest single reduction, I would re-apply current BSG surveillance guidance. Intervals have lengthened and some patients on historic protocols no longer require surveillance at all, so a guideline-based review by a consultant or a trained nurse specialist can remove a substantial proportion of the list legitimately. Only then would I do the demand and capacity analysis, because adding lists without knowing whether demand exceeds capacity structurally just moves the problem. Interventions I would test in PDSA cycles include FIT triage where it is validated for the indication, expanding nurse endoscopist capacity, insourcing, extended-day and weekend lists, and pooling lists across the unit. My outcome measure would be the number of patients overdue by risk category plotted over time; process measures would include the proportion of the list validated and the number of slots used; and my balancing measure would be waiting times for symptomatic and two-week-wait patients, because clearing surveillance must not displace suspected cancer. I would communicate honestly with patients on the list and with primary care, involve the endoscopy manager, the cancer lead and a consultant sponsor, and build the validation step into a standing process so the backlog does not simply rebuild.

Endoscopy Surveillance Backlog

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