DO ADVANCED COLONOSCOPISTS PERFORM BETTER?

Aims Colonoscopy is the ‘gold standard’ investigation for assessment of the large bowel which detects and prevents colorectal cancer, as well as non-neoplastic conditions. The Joint Advisory Group (JAG) on GI Endoscopy suggests monitoring key performance indicators such as CIR and the ADR. There has been a drive to increase utilization of endoscopy units nationwide in the UK by offering extra endoscopy lists during weekends and evenings to deal with increasing service demands. Our aim was to investigate the quality of colonoscopies carried out during Saturdays and evening lists in our unit and compare against JAG standards of quality for colonoscopies.

Tab. 1

Total	Weekdays No.=14200 ADR=28.9% CIR=90.5%	Evenings No.=1391 ADR=24.4% CIR=90.7%	Saturdays No.=2062 ADR=24.2% CIR=91.3%	P Values ADR=<0.001 CIR=0.508
Advanced colonoscopists	No.=1728 ADR=44.2% CIR=94.5%	No.=135 ADR=32.6% CIR=97%	No.=334 ADR=34.7% CIR=95.2%	ADR=<0.001 CIR=0.411
Non advanced colonoscopists	No.=12472 ADR=26.7% CIR=89.9%	No.=1256 ADR=23.5% CIR=90.0%	No.=1728 ADR=22.1% CIR=90.5%	ADR= <0.001 CIR= 0.741
Advanced vs. Non-advanced colonoscopist	P Value(ADR)=<0.001 P Value(CIR)=<0.001	P Value(ADR)= 0.019 P Value(CIR)= 0.007	P Value(ADR)=<0.001 P Value(CIR)= 0.005

Methods We retrospectively collected and analyzed demographical and procedure related data for non- screening colonoscopies performed between January 2016 and April 2018. Procedures were grouped according to the day of the week and timing of session (weekday, evening and Saturday). We also compared those performed by advanced colonoscopist and non-advanced colonoscopist. Advanced colonoscopist was defined as a BCSP colonoscopist or an advanced EMR colonscopist.

Results There were a total of 17653 colonoscopies that were carried out, 56.8% (n=10025) were less than 70 years. Table 1 summarizes the differences between weekdays, evening and Saturdays’ colonoscopies regarding the CIR and ADR. We noted that the KPIs (ADR, CIR) met the JAG standards. Advanced colonoscopists had better KPIs when compared to the non-advanced colonoscopists.

Conclusions JAG standards were maintained for colonoscopies done on weekdays, evening and Saturdays. Advanced colonoscopists had higher CIR and ADRs.Other units should explore the options of doing planned OOH colonoscopies to meet service demands.