Prospective audit of colonoscopy quality in Kent and Medway, UK

Aim: To compare the quality of colonoscopy in the Kent and Medway Strategic Health Authority with national standards and previous audits.

Method: A prospective 12-month audit of colonoscopy quality as assessed by number of procedures performed, total colonoscopy rates, sedation usage, and complications. Data were collected by 7 endoscopy units on 5905 colonoscopies performed by 62 colonoscopists. The endoscopy unit nurses, as opposed to the colonoscopists, verified that colonoscopy was total.

Results: Seven doctors stopped performing colonoscopy during the study period. Thirty-nine of 55 colonoscopists (71 %) achieved total colonoscopy in at least 90 % of cases; 12 (22 %) completed colonoscopy in 80 - 89 % of their cases and 4 (7 %) in 79 % or less of their cases. Seventy-nine percent of colonoscopists used sedation in accordance with British Society of Gastroenterology (BSG) guidelines. Only 22 of 55 (40 %) of colonoscopists performed more than 100 colonoscopies during the 12-month audit period. Reported complications were below expected levels.

Conclusion: In our study almost one-third of colonoscopists did not achieve colonoscopy completion rates of at least 90%, and less than half performed more than 100 colonoscopies during the 12 month study. Adherence to quality standards appears to be inadequate.

References

• 1 Provision of endoscopy related services in district general hospitals. Working Party of the British Society of Gastroenterology Endoscopy Committee. London; British Society of Gastroenterology Endoscopy Committee, working party report 2001
• 2 Joint Advisory Group on Gastrointestinal Endoscopy .Guidelines for the training, appraisal and assessment of trainees in gastrointestinal endoscopy and for the assessment of units for registration and re-registration. 2004 http://www.acpgbi.org.uk/documents/JAG_2004.pdf [accessed 11 Jan 2008]
• 3 NICE .Improving Outcomes in Colorectal Cancers. 2004 http://www.nice.org.uk/nicemedia/pdf/CSGCCfullguidance.pdf[accessed 11 Jan 2008]
• 4 Valori R. Quality and safety indicators for endoscopy (2007/8). http://www.bsg.org.uk/pdf_word_docs/bsg_grs_indic07.pdf [accessed 11 Jan 2008]
• 5 Bowles C JA, Leicester R, Romaya C. et al . A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?.  Gut. 2004;  53 277-283
• 6 Macrae F A, Tan K G, Williams C B. Towards safer colonoscopy; a report on the complications of 5000 diagnostic or therapeutic colonoscopies.  Gut. 1983;  24 376-383
• 7 Keeffe E B, O’Connor K W. 1989 ASGE survey of endoscopic sedation and monitoring practices.  Gastrointest Endosc. 1990;  36 S13-18
• 8 Waye J D, Lewis B S, Yessayan S. Colonoscopy: a prospective report of complications.  J Clin Gastroenterol. 1992;  15 347-351
• 9 Williams C B. Comfort and quality in colonoscopy.  Gastrointest Endosc. 1994;  40 769-770
• 10 Jentschura D, Raute M, Winter J. et al . Complications in endoscopy of the lower gastrointestinal tract. Therapy and prognosis.  Surg Endosc. 1994;  8 672-676
• 11 Quine M A, Bell G D, McCloy R F. et al . Prospective audit of upper gastrointestinal endoscopy in two regions of England: safety, staffing and sedation methods.  Gut. 1995;  36 462-467
• 12 Sieg A, Hachmöller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists.  Gastrointest Endosc. 2001;  53 620-627
• 13 Thomas-Gibson S, Thapar C, Shah S, Saunders B. Colonoscopy at a combined district general hospital and specialist endoscopy unit: lessons from 505 consecutive examinations.  J R Soc Med. 2002;  95 194-197
• 14 Fasih T, Varma J S, Tabaqchali M A. Prospective audit of quality of colonoscopy in a surgical coloproctology unit.  Surgeon. 2004;  2 107-111
• 15 Eckardt V F, Kanzler G, Scmitt T. et al . Complications and adverse effects of colonoscopy with selective sedation.  Gastrointest Endosc. 1999;  49 560-565
• 16 Denis B, Weiss A M, Peter A. et al . Quality assurance and GI endoscopy: an audit of 500 colonoscopic procedures.  Gastroenterol Clin Biol. 2004;  28 1245-1255
• 17 Scoping our practice. 2004 http://www.ncepod.org.uk/2004.htm (11/01/2008)
• 18 Lord D A, Bell G D, Gray A. et al .Sedation for Gastrointestinal Endoscopic Procedures in the Elderly: Getting Safer but Still Not Nearly Safe Enough. http://www.bsg.org.uk/pdf_word_docs/sedation_elderly.pdf [accessed 11 Jan 2008]
• 19 http://www.bsg.org.uk/clinical_prac/guidelines/sedation.htm [accessed 11 Jan 2008]
• 20 Ball J E, Osbourne J, Jowett S. et al . Quality improvement programme to achieve acceptable colonoscopy completion rates: prospective before and after study.  BMJ. 2004;  329 665-667
• 21 Bassi I, O’Toole P. Improving colonoscopy completion rates: the impact of audit.  Gut. 2003;  52 a1
• 22 Robinson J, Small P, Bell G D. et al . A prospective audit of colonoscopy in a large DGH - factors affecting caecal intubation rates.  Gut. 2001;  48(Suppl I) A10-A14
• 23 National Bowel Cancer Screening Programme. http://www.acpgbi.org.uk/documents/ColonoscopyACPGBI.doc [accessed 11 Jan 2008]
• 24 Green J. Complications of Gastrointestinal Endoscopy. http://www.bsg.org.uk/pdf_word_docs/complications.pdf [accessed 11 Jan 2008]
• 25 Hardcastle J D, Chamberlain J O, Robinson M HR. et al . Randomised controlled trial of faecal occult blood screening for colorectal cancer.  Lancet. 1996;  348 1472-1477
• 26 Valori R. A guide to auditing quality and safety items of the Endoscopy Global Rating Scale. Available as download from http://www.grs.nhs.uk from the link ‘A guide for quality items for GRS’ [accessed 11 Jan 2008]