Nurse-led colonoscopy model ensure adherence to guidelines

A nurse-co-ordinated model of colorectal cancer surveillance in public hospitals achieves better compliance with guideline recommendations than physician-led recall in private hospitals, research from South Australia shows.

An audit of the long-running Southern Co-operative Program for the Prevention of Colorectal Cancer (SCOOP) covering a three month period in 2015 found that recall recommendations matched surveillance guidelines in 97.1% of cases under the nurse-led model in public academic hospitals, compared to 83% with the physician-led model.

During the audit period, 27% of colonoscopies in public hospitals and 20% of those in private hospitals were performed more than six months earlier than scheduled. In most cases, colonoscopies were done ahead of schedule due to patient-related factors such as symptoms or a positive FOBT, according to the evaluation published in the MJA.

The audit also found that the ratio of high risk adenomas to cancers identified in the SCOOP program increased from 6.6:1 in 2001-2005 to 16:1 during the 2011-2015 period. This showed the success of ongoing surveillance, the study authors said.

The findings showed that nurse-coordinators helped improve adherence to surveillance guidelines, avoid inappropriately frequent surveillance and thus reduce endoscopy workloads, they added.

“Having a process in place that allows for long term compliance with surveillance guidelines will promote optimal health care, as procedures performed to frequently can increase risks to patients, are expensive, and lengthen waiting lists,” wrote Dr Erin Symonds, senior scientist for Flinders Medical Centre, based at the Flinders Centre for Innovation in Cancer, in Adelaide.

She noted that compliance with surveillance guidelines had been only 46% prior to the SCOOP model being implemented in 1999, but had increased to greater than 80% among physicians and even higher rates with nurse co-ordinators.

The rate of early colonoscopy procedures outside the SCOOP model was as high as 76%, and this might be due to gastroenterologists applying their clinical knowledge to surveillance recommendations in individual cases, she suggested.

“Not all early procedures are inappropriate; we have previously reported an increased yield of  advanced neoplasia at early colonoscopies triggered by positive FOBT results.”

“Published guidelines guide best practice at the population level, but a specialist may decide that they are not applicable to an individual presenting with features not covered by their recommendation,” wrote Dr Symonds.

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