Background
Safer Care Victoria, along with Director of Surgery, Professor David Watters and A/Professor Iain Skinner, colorectal surgeon co-led the Colonoscopy roundtable discussion to identify the major influences and issues surrounding colonoscopy practice in Victoria, with the intention of developing guidance for required changes to ensure the highest standard of quality and safety in all facets of colonoscopy practice.
Read the full report >
Recommendations
The roundtable resulted in the development of seven recommendations:
Timeliness of colonoscopy
(a) Following referral, triage and assessment, the booking of planned (elective) colonoscopies should follow the national elective (planned) surgical urgency categorisation of 30, 90 and 365 days.
(b) Patients with a positive faecal occult blood test (FOBT) should undergo diagnostic colonoscopy within a maximum of four months after the date of their FOBT test, as should patients referred with critical or red flag symptoms. Four months is a maximum and it is recognised that some symptomatic patients warrant much earlier colonoscopy.
Consent for colonoscopy
Patients should be appropriately consented which includes an understanding of potential complications, factors relating to duration and technical performance of their procedure, and the timing of appropriate colonoscopy surveillance intervals in relation to any previous colonoscopy.
Facility Scheduling of Colonoscopy Lists
Colonoscopy scheduling should occur at no less than 30-minute intervals to allow adequate time to complete a high-quality withdrawal protocol that ensures thorough inspection of the entire mucosal surface. Where a gastroscopy is also performed on the same patient, a minimum of 15 minutes should be scheduled for the gastroscopy.
Facility performance metrics
That providers of colonoscopy continue to measure and review objective endoscopist and facility quality metrics for internal quality assurance and accreditation against national standards.
Communication of results and appropriate surveillance after endoscopy
Colonoscopy findings and pathology should be communicated to patient and referring practitioner to facilitate further management and appropriate surveillance. Organisational support is required at hospital and health system level to ensure that surveillance intervals align with the established evidence-based standards.
Assessment of competence and performance during and after training
Objective quality metrics and objective assessment tools should be utilised to assess progress during training, assess competence at completion of training, for re-certification of practice, to certify extended scopes of practice, and for ongoing clinical professional development.
Addressing inequity of access to colonoscopy
That the needs and access to colonoscopy by indigenous patients, rural and remote patients, and patients living in lower socioeconomic areas, and patients who have limited access to healthcare for any other reasons, are considered and addressed. This may include utilising investigations such as CT (Computed Tomography) colonography where these are more readily available.