The Health Information and Quality Authority is asking for comments on draft recommended thresholds that should be met before patients are referred for selected scheduled gastrointestinal procedures.  

HIQA’s Director of Health Technology Assessment Dr Máirín Ryan said: “Despite significant increased activity by general surgery and gastrointestinal services over recent years, demand continues to exceed resource availability, with consequent pressure on waiting lists. It is in this context that these HTAs aim to ensure that the right patients receive referral and treatment at the right time and, in particular, that unnecessary referral is avoided in those people who are unlikely to get additional benefit from intervention over other treatment options.”

This latest phase in a series of health technology assessments focuses on referral thresholds for patients with upper and lower gastrointestinal symptoms who may require OGD or colonoscopy to rule out malignancy, and on referral thresholds for those who may require gallbladder removal, groin hernia repair or surgical intervention for haemorrhoids.

Fair and equal access to these interventions as well as the needs and expectations of individual patients need to be balanced with the requirement to maximise health gain for the population as a whole.

“It is intended that these reports will provide clarity around referral for GPs, other referring doctors and their patients.  The draft reports have been developed based on a comprehensive review of the international literature and in consultation with an expert advisory group. Public and healthcare professional consultation on the draft recommendations is therefore important and we will revise the reports as appropriate based on feedback received,” Dr Ryan said.

The consultation on these draft recommended referral thresholds for scheduled gastrointestinal procedures will run until 29 August 2014. The reports, along with details on how to take part in the consultation, are available here.

The completed reports will be submitted to the HSE and to the Minister for Health.

Further Information: 

Sinead Whooley, Communications Manager, Health Information and Quality Authority, 01 814 7488/ 087 9221941swhooley@hiqa.ie

Notes to the Editor: 

• HIQA is the statutory organisation in Ireland with a responsibility to carry out national health technology assessments (HTAs) and to develop guidelines for the conduct of HTAs across our healthcare system.
• The referral thresholds which are included in Phase IV of this series of HTAs include:
• Referral thresholds for patients with lower gastrointestinal symptoms suspected of indicating malignancy
• Referral thresholds for patients with upper gastrointestinal symptoms suspected of indicating malignancy
• Referral thresholds for adult patients with groin (inguinal or femoral) hernia
• Referral thresholds for adult patients suspected of having gallstone disease
• Referral thresholds for haemorrhoid procedures
• Supporting documents include the ‘Background and Methods – Phase IV’ and ‘Ethical Analysis’ documents.
• Upper GI endoscopy, otherwise known as a gastro-oesophago-duodenoscopy (OGD), involves the passage of a flexible fibre-optic endoscope through the mouth, throat, oesophagus, stomach, and duodenum, and is generally performed as a day case under sedation or with topical anaesthesia to the oropharynx.
• Colonoscopy involves fibre-optic examination of the entire large bowel, and is generally performed as a day case under sedation.
• Sigmoidoscopy involves limited fibre-optic examination of the large bowel.
• The number of elective colonoscopies or sigmidoscopies undertaken in the publicly-funded healthcare system increased by 67.2% from 39,936 in 2005 to 66,760 in 2012.
• The number of elective upper GI endoscopies undertaken in the publicly-funded healthcare system increased by 44% from 41,803 in 2005 to 60,038 in 2012.