Nursing Times feature: Leicester's capsule sponge nurses expand EndoSign testing to the community
University Hospitals of Leicester NHS Trust (UHL) has transformed patient access to diagnostics for Barrett’s oesophagus, a risk factor for cancer, through the roll out of capsule sponge testing. The team’s creation of a new nurse-led diagnostic pathway has allowed them to cut gastroscopy waiting times, improve clinical capacity and deliver a better experience for both patients and clinical staff.
Leicester’s pioneering capsule nurses bring capsule sponge testing to the community
Nurses at University Hospitals of Leicester NHS Trust (UHL) have transformed patient diagnosis of the condition, by moving the procedure out of the hospital setting.
The move has seen a 20-week reduction in patient waiting times and has gathered positive feedback from patients.
How the test works
The capsule sponge test is available to patients with symptoms of gastro-oesophageal reflux disease such as acid reflux or heartburn and is being offered as a less invasive alternative to endoscopy.
The procedure involves patients swallowing a small capsule-shaped device that contains a tiny sponge.
The sponge then expands in the stomach and collects cell samples for analysis as it is being extracted via an attached string.
It can be used to diagnose Barrett’s oesophagus, a condition where oesophageal cells grow abnormally, which can lead to cancer if undiagnosed.
Introducing the test to Leicester
The NHS began piloting the test across trusts during the pandemic, due to increased pressure on services and a growing backlog for endoscopy.
Findings from the pilot, published this year, revealed that thousands of patients had benefitted from the sponge on a string test.
Nurses – who often perform the procedure in hospitals – have now paved the way for it to be undertaken in the community too.
At UHL, specialist nurses had noticed that the trust was facing all-time high waits for gastroscopy and wanted to introduce the capsule sponge test out in the community to combat it.
Initially it was rolled out at St Luke’s Hospital in Market Harborough, and has since been extended to two further community hospital sites.
Capsule sponge nurse feedback
Colette Green, a community matron at the trust, told Nursing Times that when they initially began the rollout in the community, they were fitting it around their usual workload at the hospital.
“We didn’t get any extra time or funding when we originally started,” she explained.
“As with a lot of these things, sometimes you have to take a bit of a risk.”
Ms Green noted that the procedure was “better for patients and gets done a lot quicker” because there is no need for sedation.
In addition, she said it was a cost-saving procedure because it just requires one nurse and their equipment.
Creating a nurse-lead capsule sponge clinic
Following a funding injection, the trust decided to create a permanent nurse-led clinic to undertake the procedure across different community hospital sites.
The nurses now work within a 17-mile radius of the city to undertake the procedure.
Vanessa de Vivian, lead capsule sponge clinical nurse specialist at the trust, told Nursing Times that the pilot had provided her with the opportunity to be upskilled.
She noted that, in some cases, band 6 endoscopy nurses were “very limited” in where and how they could progress.
“I was looking at alternative employment and what I could do to specialise,” Ms de Vivian explained.
“Then we fell upon this, and it’s something that I am passionate about, and I’ve now gone from a band 6 to a band 7, leading the service and setting up a service – it is absolutely fantastic."
She added: “It’s nice to have the opportunity to actually work independently.
“People have confidence in us as nurses, to allow us some scope to be able to do that.”
So far, the team has done the procedure on more than 560 patients and have received lots of positive feedback.
It has resulted in a 20-week reduction in patient waiting times, as well as making testing available to more sites across Leicester.
All patients who previously had other gastroscopy procedures said they would prefer to have a capsule sponge test in the future.
Meanwhile, 99% of patients said they experienced little to no discomfort during or after their capsule sponge test.
UHL has plans to expand the reach of the community-led sponge on a string test.
Expansion plans
Ms Green said the trust was looking to take on more band 6 nurses to carry out the procedure in the community.
“It frees up the clinicians and nurse endoscopists to concentrate on the more complex procedures and things that need to be done in an endoscopy room in an acute setting,” she explained.
Meanwhile, the trust is working to change the criteria for referrals from GPs so that they can directly refer patients to have the sponge on a string procedure.
The vision is that, in time, capsule sponge testing will be offered as a first-line diagnostic procedure for those with gastro-oesophageal reflux disease.
It comes as there are still many people in the community self-medicating for acid reflux who should be offered a test, explained Ms de Vivian.
“There’s many people undiagnosed with Barrett oesophagus,” she said.
“Obviously we know in the medical field that that can lead to oesophageal cancer.”
Separately, Ms de Vivian noted that other hospital trusts had taken an interest in UHL’s work.
She said that she had so far attended meetings with six nearby hospital trusts to see how the procedure could be replicated at other organisations.
Ms de Vivian said: “I think it’s really good if you get nurses with a passion who are already doing [gastroscopy].
“I believe in it, and I think it should be [rolled out] across the UK.”
