Most patients access gastroenterology services via an outpatient department for rapid diagnosis and treatment. Many units prioritise appointments according to the ’red flag’ criteria (specified in the 2-week referral rule for suspected cancer pathways), urgent and routine pathways. There is increasing demand for patients with mild symptoms to exclude serious disease such as cancer and IBD. Often these patients are only seen once in the outpatient department and are discharged back to GP care after endoscopic and radiological investigation has proved negative for serious disease. Patients with chronic gastrointestinal disease such as IBD, chronic liver disease, complex dyspepsia or gastrointestinal motility disorders are managed in the outpatient department with repeated follow-up consultations. Some gastroenterology departments provide a telephone follow-up service for patients with chronic disease in remission.
There is an increasing trend for patients to be referred by their GP directly for endoscopic investigation without a prior outpatient consultation (open access endoscopy) according to locally agreed care pathways. Such care pathways facilitate easier patient access to secondary care services and investigation and also enable greater efficiency.
Patients with gastroenterological emergencies such as acute gastrointestinal bleeding, severe diarrhoea, jaundice, liver failure or acute severe abdominal pain present directly to the accident and emergency department and are initially managed as inpatients before outpatient follow-up.
Other hospital specialties, eg geriatric medicine, GIM and surgery, frequently refer patients to both inpatient and outpatient gastroenterology services.