New colonoscopy standard launched at AGW for 2019

Cancer

By Mardi Chapman

10 Sep 2018

Prof Anne Duggan

The new Colonoscopy Clinical Care Standard will go a long way to ensuring high quality and timely colonoscopies are available for the people who need them.

Launched at Australian Gastroenterology Week 2018 in Brisbane by the Australian Commission on Safety and Quality in Health Care (ACSQHC), the document is designed to inform patients, clinicians and health services.

It comprises nine quality statements from assessment and referral to reporting and follow-up underpinned by clinical practice guidelines for surveillance colonoscopy, bowel cancer prevention, early detection and management, perioperative care for day surgery, and sedation and anaesthesia.

Clinical director of the Commission Professor Anne Duggan told the limbic that health service organisations will be assessed to the new standard from January 2019.

“There will be a transition period for all facilities being accredited in 2019 but going forward into the future, the standard will be expected and that will be what facilities are measured by.”

“What’s important for gastroenterologists is we have emphasised the importance of a good quality referral and what’s really good for GPs and consumers is we have emphasised the importance of high quality reports with the histopathology and advice about when it needs to be redone, if it needs to be redone.”

“If you follow evidence-based guidelines for surveillance, then you free up waiting lists. I think what the Colonoscopy Clinical Care Standard will do is help with the waiting list, but it also means that if you are a patient waiting, you at least know that the person ahead of you is more needy and the person behind you is less needy.”

As well as best clinical evidence for high quality colonoscopy, the Colonoscopy Clinical Care Standard also incorporates ‘all the things we know about health literacy, ensuring patients are partners in their care and informed consent’.

“We’ve got so much happening in this space. At the same time, the Conjoint Committee [for Recognition of Training in Gastrointestinal Endoscopy] has been working on certification and recertification so there was an opportunity to say what a high quality proceduralist looks like,” Professor Duggan said.

She added that there was broad agreement on the standard and a desire to do more.

“One of the few issues people are still worried about is how long proceduralists are taking to do the colonoscopy – are they spending enough time to be really looking for adenomas – and are they putting too many people on their lists? We know people tire – are you as good at the end of your list as you are at the beginning?”

Guidance on those issues was still to be decided, she said.

The Standard calls for communications to include whether or not patients are referred from a positive FOBT in the National Bowel Cancer Screening Program (NBCSP) and to close the loop by reporting outcomes to the NBCSP Register.

“Part of it was a desire to raise awareness that we have a really effective bowel cancer screening program. There is disappointment that we only have about a 40% participation rate in the NBCSP and we know from the modelling, that if we have better participation we would save lots of lives. There would be a 30% reduction in mortality and we would save so much morbidity,” Professor Duggan said.

She added it was really important for consumers to understand the Colonoscopy Clinical Care Standard.

“Many people haven’t felt entitled to ask why am I having it now? What do I need to do? What do you mean? I think it’s great for consumers to actually ask the questions because it gives them more of a partnership role.”

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