Why wait for a colonoscopy An easy cure

1
Why wait for a colonoscopy? An easy cure

• National Development
• Programme
• October 6th/7th 2005
• Nick Taffinder
• William Harvey Hospital,
• Ashford Kent

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Introduction

• High risk groups screened for colonic neoplasia
• Previous bowel cancer
• Polyps
• Family history
• Wide variation in practice
• Frequency
• Age
• Polyp risk

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ACPGBI and BSG Guidelines October 2002
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Risk of cancer after polyp excisionhigh risk
4
Long-term risk of colorectal cancer after
excision of rectosigmoid adenomas.Atkin WS,
Morson BC, Cuzick J. N Engl J Med. 1992 Mar
5326(10)658-62.
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Risk of cancer after polyp excisionlow risk
0.3
Long-term risk of colorectal cancer after
excision of rectosigmoid adenomas.Atkin WS,
Morson BC, Cuzick J. N Engl J Med. 1992 Mar
5326(10)658-62.
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Risk of perforation low risk - 0.2
Single flexible sigmoidoscopy screening to
prevent colorectal cancer baseline findings of
a UK multicentre randomised trial. Lancet. 2002
Apr 13359(9314)1291-300.
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Aims

• Compare our waiting list with the guidelines
• anticipate high non-compliance
• Remove patients from list
• anticipate resistance from
• patients
• clinicians
• Investigate the impact on diagnostic delivery
• anticipate
• reduction in numbers on list
• reversal of surveillance diagnostic ratio
• faster patient journey for diagnosis

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Methods

• Three researchers trained in guidelines
• Standard proforma to assess notes
• 4837 patients on waiting list in network
• Standard letters sent to all patients
• Cancel
• Re-booked for later date
• Apologies for delay and reassure

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4837 patients on waiting list
Diagnosticsurveillance ratio 12
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2369 (49) are unneccessary
Diagnosticsurveillance ratio 31
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It must be the trainees who are booking
inappropriate tests.
Junior grades booked half the tests
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Perhaps it just surgeons who havent read the
guidelines
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But surely we have all changed practice since
the guidelines?
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The Problem
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Current compliance with 62 day rule 27
62 day target
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Impact on our waiting times for colonoscopy
?
Pre-audit
Post-audit
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The Problem
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Conclusion

• 80 of our surveillance waiting list could be cut
• Equivalent to 50 of our total waiting list
• Diagnostic colonoscopy rates will increase
• Reduce waiting times for diagnostic colonoscopy
• Enable compliance with 62 day target
• Avoid unnecessary perforation/ bleeding
• Save valuable resources
• 2369 _at_ 500 1.2 million savings
  (pop1.5million)
• Potential savings to NHS gt 40 million (pop 60
  million)

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What next?

• SCAR Team (surveillance colonoscopy audit
  review)
• Proformas and researchers
• Software SPSS database
• Template letters
• Printed reports
• Educational package
• within endoscopy
• in clinics
• Face to face with clinicians

Nick.Taffinder_at_ekht.nhs.uk