Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme
ObjectivesColonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood (FOB) testing to 60–74 year olds and colonoscopy to those with positive FOB tests....
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| Published in | Gut Vol. 61; no. 7; pp. 1050 - 1057 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
BMJ Publishing Group Ltd and British Society of Gastroenterology
01.07.2012
BMJ Publishing Group BMJ Publishing Group LTD |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0017-5749 1468-3288 1468-3288 |
| DOI | 10.1136/gutjnl-2011-300651 |
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| Abstract | ObjectivesColonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood (FOB) testing to 60–74 year olds and colonoscopy to those with positive FOB tests. All colonoscopists in the screening programme are required to meet predetermined standards before starting screening and are subject to ongoing quality assurance. In this study, the authors examine the quality of colonoscopy in the NHS BCSP and describe new and established measures to assess and maintain quality.DesignThe NHS BCSP database collects detailed data on all screening colonoscopies. Prospectively collected data from the first 3 years of the programme (August 2006 to August 2009) were analysed. Colonoscopy quality indicators (adenoma detection rate (ADR), polyp detection rate, colonoscopy withdrawal time, caecal intubation rate, rectal retroversion rate, polyp retrieval rate, mean sedation doses, patient comfort scores, bowel preparation quality and adverse event incidence) were calculated along with measures of total adenoma detection.Results2 269 983 individuals returned FOB tests leading to 36 460 colonoscopies. Mean unadjusted caecal intubation rate was 95.2%, and mean withdrawal time for normal procedures was 9.2 min. The mean ADR per colonoscopist was 46.5%. The mean number of adenomas per procedure (MAP) was 0.91; the mean number of adenomas per positive procedure (MAP+) was 1.94. Perforation occurred after 0.09% of procedures. There were no procedure-related deaths.ConclusionsThe NHS BCSP provides high-quality colonoscopy, as demonstrated by high caecal intubation rate, ADR and comfort scores, and low adverse event rates. Quality is achieved by ensuring BCSP colonoscopists meet a high standard before starting screening and through ongoing quality assurance. Measuring total adenoma detection (MAP and MAP+) as adjuncts to ADR may further enhance quality assurance. |
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| AbstractList | Objectives Colonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood (FOB) testing to 60–74 year olds and colonoscopy to those with positive FOB tests. All colonoscopists in the screening programme are required to meet predetermined standards before starting screening and are subject to ongoing quality assurance. In this study, the authors examine the quality of colonoscopy in the NHS BCSP and describe new and established measures to assess and maintain quality. Design The NHS BCSP database collects detailed data on all screening colonoscopies. Prospectively collected data from the first 3 years of the programme (August 2006 to August 2009) were analysed. Colonoscopy quality indicators (adenoma detection rate (ADR), polyp detection rate, colonoscopy withdrawal time, caecal intubation rate, rectal retroversion rate, polyp retrieval rate, mean sedation doses, patient comfort scores, bowel preparation quality and adverse event incidence) were calculated along with measures of total adenoma detection. Results 2 269 983 individuals returned FOB tests leading to 36 460 colonoscopies. Mean unadjusted caecal intubation rate was 95.2%, and mean withdrawal time for normal procedures was 9.2 min. The mean ADR per colonoscopist was 46.5%. The mean number of adenomas per procedure (MAP) was 0.91; the mean number of adenomas per positive procedure (MAP+) was 1.94. Perforation occurred after 0.09% of procedures. There were no procedure-related deaths. Conclusions The NHS BCSP provides high-quality colonoscopy, as demonstrated by high caecal intubation rate, ADR and comfort scores, and low adverse event rates. Quality is achieved by ensuring BCSP colonoscopists meet a high standard before starting screening and through ongoing quality assurance. Measuring total adenoma detection (MAP and MAP+) as adjuncts to ADR may further enhance quality assurance. ObjectivesColonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood (FOB) testing to 60–74 year olds and colonoscopy to those with positive FOB tests. All colonoscopists in the screening programme are required to meet predetermined standards before starting screening and are subject to ongoing quality assurance. In this study, the authors examine the quality of colonoscopy in the NHS BCSP and describe new and established measures to assess and maintain quality.DesignThe NHS BCSP database collects detailed data on all screening colonoscopies. Prospectively collected data from the first 3 years of the programme (August 2006 to August 2009) were analysed. Colonoscopy quality indicators (adenoma detection rate (ADR), polyp detection rate, colonoscopy withdrawal time, caecal intubation rate, rectal retroversion rate, polyp retrieval rate, mean sedation doses, patient comfort scores, bowel preparation quality and adverse event incidence) were calculated along with measures of total adenoma detection.Results2 269 983 individuals returned FOB tests leading to 36 460 colonoscopies. Mean unadjusted caecal intubation rate was 95.2%, and mean withdrawal time for normal procedures was 9.2 min. The mean ADR per colonoscopist was 46.5%. The mean number of adenomas per procedure (MAP) was 0.91; the mean number of adenomas per positive procedure (MAP+) was 1.94. Perforation occurred after 0.09% of procedures. There were no procedure-related deaths.ConclusionsThe NHS BCSP provides high-quality colonoscopy, as demonstrated by high caecal intubation rate, ADR and comfort scores, and low adverse event rates. Quality is achieved by ensuring BCSP colonoscopists meet a high standard before starting screening and through ongoing quality assurance. Measuring total adenoma detection (MAP and MAP+) as adjuncts to ADR may further enhance quality assurance. Objectives Colonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood (FOB) testing to 60-74 year olds and colonoscopy to those with positive FOB tests. All colonoscopists in the screening programme are required to meet predetermined standards before starting screening and are subject to ongoing quality assurance. In this study, the authors examine the quality of colonoscopy in the NHS BCSP and describe new and established measures to assess and maintain quality. Design The NHS BCSP database collects detailed data on all screening colonoscopies. Prospectively collected data from the first 3 years of the programme (August 2006 to August 2009) were analysed. Colonoscopy quality indicators (adenoma detection rate (ADR), polyp detection rate, colonoscopy withdrawal time, caecal intubation rate, rectal retroversion rate, polyp retrieval rate, mean sedation doses, patient comfort scores, bowel preparation quality and adverse event incidence) were calculated along with measures of total adenoma detection. Results 2â[euro]^269â[euro]^983 individuals returned FOB tests leading to 36â[euro]^460 colonoscopies. Mean unadjusted caecal intubation rate was 95.2%, and mean withdrawal time for normal procedures was 9.2 min. The mean ADR per colonoscopist was 46.5%. The mean number of adenomas per procedure (MAP) was 0.91; the mean number of adenomas per positive procedure (MAP+) was 1.94. Perforation occurred after 0.09% of procedures. There were no procedure-related deaths. Conclusions The NHS BCSP provides high-quality colonoscopy, as demonstrated by high caecal intubation rate, ADR and comfort scores, and low adverse event rates. Quality is achieved by ensuring BCSP colonoscopists meet a high standard before starting screening and through ongoing quality assurance. Measuring total adenoma detection (MAP and MAP+) as adjuncts to ADR may further enhance quality assurance. Colonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood (FOB) testing to 60-74 year olds and colonoscopy to those with positive FOB tests. All colonoscopists in the screening programme are required to meet predetermined standards before starting screening and are subject to ongoing quality assurance. In this study, the authors examine the quality of colonoscopy in the NHS BCSP and describe new and established measures to assess and maintain quality. The NHS BCSP database collects detailed data on all screening colonoscopies. Prospectively collected data from the first 3 years of the programme (August 2006 to August 2009) were analysed. Colonoscopy quality indicators (adenoma detection rate (ADR), polyp detection rate, colonoscopy withdrawal time, caecal intubation rate, rectal retroversion rate, polyp retrieval rate, mean sedation doses, patient comfort scores, bowel preparation quality and adverse event incidence) were calculated along with measures of total adenoma detection. 2,269,983 individuals returned FOB tests leading to 36,460 colonoscopies. Mean unadjusted caecal intubation rate was 95.2%, and mean withdrawal time for normal procedures was 9.2 min. The mean ADR per colonoscopist was 46.5%. The mean number of adenomas per procedure (MAP) was 0.91; the mean number of adenomas per positive procedure (MAP+) was 1.94. Perforation occurred after 0.09% of procedures. There were no procedure-related deaths. The NHS BCSP provides high-quality colonoscopy, as demonstrated by high caecal intubation rate, ADR and comfort scores, and low adverse event rates. Quality is achieved by ensuring BCSP colonoscopists meet a high standard before starting screening and through ongoing quality assurance. Measuring total adenoma detection (MAP and MAP+) as adjuncts to ADR may further enhance quality assurance. ObjectivesColonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood (FOB) testing to 60-74year olds and colonoscopy to those with positive FOB tests. All colonoscopists in the screening programme are required to meet predetermined standards before starting screening and are subject to ongoing quality assurance. In this study, the authors examine the quality of colonoscopy in the NHS BCSP and describe new and established measures to assess and maintain quality.DesignThe NHS BCSP database collects detailed data on all screening colonoscopies. Prospectively collected data from the first 3years of the programme (August 2006 to August 2009) were analysed. Colonoscopy quality indicators (adenoma detection rate (ADR), polyp detection rate, colonoscopy withdrawal time, caecal intubation rate, rectal retroversion rate, polyp retrieval rate, mean sedation doses, patient comfort scores, bowel preparation quality and adverse event incidence) were calculated along with measures of total adenoma detection.Results2[puncsp]269[puncsp]983 individuals returned FOB tests leading to 36[puncsp]460 colonoscopies. Mean unadjusted caecal intubation rate was 95.2%, and mean withdrawal time for normal procedures was 9.2min. The mean ADR per colonoscopist was 46.5%. The mean number of adenomas per procedure (MAP) was 0.91; the mean number of adenomas per positive procedure (MAP+) was 1.94. Perforation occurred after 0.09% of procedures. There were no procedure-related deaths.ConclusionsThe NHS BCSP provides high-quality colonoscopy, as demonstrated by high caecal intubation rate, ADR and comfort scores, and low adverse event rates. Quality is achieved by ensuring BCSP colonoscopists meet a high standard before starting screening and through ongoing quality assurance. Measuring total adenoma detection (MAP and MAP+) as adjuncts to ADR may further enhance quality assurance. Colonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood (FOB) testing to 60-74 year olds and colonoscopy to those with positive FOB tests. All colonoscopists in the screening programme are required to meet predetermined standards before starting screening and are subject to ongoing quality assurance. In this study, the authors examine the quality of colonoscopy in the NHS BCSP and describe new and established measures to assess and maintain quality.OBJECTIVESColonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood (FOB) testing to 60-74 year olds and colonoscopy to those with positive FOB tests. All colonoscopists in the screening programme are required to meet predetermined standards before starting screening and are subject to ongoing quality assurance. In this study, the authors examine the quality of colonoscopy in the NHS BCSP and describe new and established measures to assess and maintain quality.The NHS BCSP database collects detailed data on all screening colonoscopies. Prospectively collected data from the first 3 years of the programme (August 2006 to August 2009) were analysed. Colonoscopy quality indicators (adenoma detection rate (ADR), polyp detection rate, colonoscopy withdrawal time, caecal intubation rate, rectal retroversion rate, polyp retrieval rate, mean sedation doses, patient comfort scores, bowel preparation quality and adverse event incidence) were calculated along with measures of total adenoma detection.DESIGNThe NHS BCSP database collects detailed data on all screening colonoscopies. Prospectively collected data from the first 3 years of the programme (August 2006 to August 2009) were analysed. Colonoscopy quality indicators (adenoma detection rate (ADR), polyp detection rate, colonoscopy withdrawal time, caecal intubation rate, rectal retroversion rate, polyp retrieval rate, mean sedation doses, patient comfort scores, bowel preparation quality and adverse event incidence) were calculated along with measures of total adenoma detection.2,269,983 individuals returned FOB tests leading to 36,460 colonoscopies. Mean unadjusted caecal intubation rate was 95.2%, and mean withdrawal time for normal procedures was 9.2 min. The mean ADR per colonoscopist was 46.5%. The mean number of adenomas per procedure (MAP) was 0.91; the mean number of adenomas per positive procedure (MAP+) was 1.94. Perforation occurred after 0.09% of procedures. There were no procedure-related deaths.RESULTS2,269,983 individuals returned FOB tests leading to 36,460 colonoscopies. Mean unadjusted caecal intubation rate was 95.2%, and mean withdrawal time for normal procedures was 9.2 min. The mean ADR per colonoscopist was 46.5%. The mean number of adenomas per procedure (MAP) was 0.91; the mean number of adenomas per positive procedure (MAP+) was 1.94. Perforation occurred after 0.09% of procedures. There were no procedure-related deaths.The NHS BCSP provides high-quality colonoscopy, as demonstrated by high caecal intubation rate, ADR and comfort scores, and low adverse event rates. Quality is achieved by ensuring BCSP colonoscopists meet a high standard before starting screening and through ongoing quality assurance. Measuring total adenoma detection (MAP and MAP+) as adjuncts to ADR may further enhance quality assurance.CONCLUSIONSThe NHS BCSP provides high-quality colonoscopy, as demonstrated by high caecal intubation rate, ADR and comfort scores, and low adverse event rates. Quality is achieved by ensuring BCSP colonoscopists meet a high standard before starting screening and through ongoing quality assurance. Measuring total adenoma detection (MAP and MAP+) as adjuncts to ADR may further enhance quality assurance. |
| Author | Nickerson, Claire Patnick, Julietta Rees, Colin J Blanks, Roger G Moss, Sue M Chilton, Andrew Rutter, Matthew D Lee, Thomas J W Goddard, Andrew F McNally, Richard J Q |
| Author_xml | – sequence: 1 givenname: Thomas J W surname: Lee fullname: Lee, Thomas J W email: tomlee@doctors.org.uk organization: Northern Region Endoscopy Group (NREG) South Tyneside District Hospital, Harton Lane, South Shields, Tyne and Wear, UK – sequence: 2 givenname: Matthew D surname: Rutter fullname: Rutter, Matthew D email: tomlee@doctors.org.uk organization: Durham University, Queen's Campus, University Boulevard, Stockton-on-Tees, UK – sequence: 3 givenname: Roger G surname: Blanks fullname: Blanks, Roger G email: tomlee@doctors.org.uk organization: Cancer Epidemiology Unit, Oxford, UK – sequence: 4 givenname: Sue M surname: Moss fullname: Moss, Sue M email: tomlee@doctors.org.uk organization: Cancer Screening Evaluation Unit, Institute of Cancer Research, University of London, Sutton, London, UK – sequence: 5 givenname: Andrew F surname: Goddard fullname: Goddard, Andrew F email: tomlee@doctors.org.uk organization: Derbyshire Bowel Cancer Screening Centre, Derby City General Hospital, Derby, UK – sequence: 6 givenname: Andrew surname: Chilton fullname: Chilton, Andrew email: tomlee@doctors.org.uk organization: Northants and Rutland Bowel Cancer Screening Centre, Kettering General Hospital, Kettering, UK – sequence: 7 givenname: Claire surname: Nickerson fullname: Nickerson, Claire email: tomlee@doctors.org.uk organization: NHS Cancer Screening Programmes, Sheffield, UK – sequence: 8 givenname: Richard J Q surname: McNally fullname: McNally, Richard J Q email: tomlee@doctors.org.uk organization: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK – sequence: 9 givenname: Julietta surname: Patnick fullname: Patnick, Julietta email: tomlee@doctors.org.uk organization: NHS Cancer Screening Programmes, Sheffield, UK – sequence: 10 givenname: Colin J surname: Rees fullname: Rees, Colin J email: tomlee@doctors.org.uk organization: South of Tyne Bowel Cancer Screening Centre, South Tyneside General Hospital, South Shields, UK |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25954135$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/21940723$$D View this record in MEDLINE/PubMed |
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| Copyright | 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. 2015 INIST-CNRS Copyright: 2012 (c) 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. |
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| References | Atkin, Rogers, Cardwell 2004; 126 Millan, Gross, Manilich 2008; 51 Cotton, Eisen, Aabakken 2010; 71 Bretagne, Hamonic, Piette 2010; 71 Johnson, Gurney, Volpe 1990; 85 Bell, McCloy, Charlton 1991; 32 Regula, Rupinski, Kraszewska 2006; 355 Nelson, McQuaid, Bond 2002; 55 Kronberg, Fenger, Olsen 1996; 348 Panteris, Haringsma, Kuipers 2009; 41 Mandel, Church, Bond 2000; 343 Kaminski, Regula, Kraszewska 2010; 362 Ellis, Coleman, Wells 2006; 59 Bowles, Leicester, Romaya 2004; 53 Crispin, Birkner, Munte 2009; 41 Rex, Bond, Winawer 2002; 97 2004; 329 Rex 1995; 90 Weller, Coleman, Robertson 2007; 97 Benson, Patnick, Davies 2008; 122 |
| References_xml | – volume: 362 start-page: 1795 year: 2010 article-title: Quality indicators for colonoscopy and the risk of interval cancer publication-title: N Engl J Med – volume: 355 start-page: 1863 year: 2006 article-title: Colonoscopy in colorectal cancer screening for detection of advanced neoplasia publication-title: N Engl J Med – volume: 55 start-page: 307 year: 2002 article-title: Procedural success and complications of large-scale screening colonoscopy publication-title: Gastrointest Endosc – volume: 97 start-page: 1296 year: 2002 article-title: Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer publication-title: Am J Gastroenterol – volume: 32 start-page: 725 year: 1991 article-title: Recommendations for standards of sedation and patient monitoring during gastrointestinal endoscopy publication-title: Gut – volume: 343 start-page: 1603 year: 2000 article-title: The effect of fecal occult blood screening on the incidence of colorectal cancer publication-title: N Engl J Med – volume: 90 start-page: 353 year: 1995 article-title: Colonoscopy: a review of its yield for cancers and adenomas by indication publication-title: Am J Gastroenterol – volume: 348 start-page: 1467 year: 1996 article-title: Randomised study of screening for colorectal cancer with faecal occult blood test publication-title: Lancet – volume: 71 start-page: 335 year: 2010 article-title: Variations between endoscopists in rates of detection of colorectal neoplasia and their impact on a regional screening programme based on colonoscopy after fecal occult blood testing publication-title: Gastrointest Endosc – volume: 122 start-page: 1357 year: 2008 article-title: Colorectal cancer screening: a comparison of 35 initiatives in 17 countries publication-title: Int J Cancer – volume: 59 start-page: 138 year: 2006 article-title: Impact of a national external quality assessment scheme for breast pathology in the UK publication-title: J Clin Pathol – volume: 53 start-page: 277 year: 2004 article-title: A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow? publication-title: Gut – volume: 51 start-page: 1217 year: 2008 article-title: Adenoma detection rate: the real indicator of quality in colonoscopy publication-title: Dis Col Rectum – volume: 71 start-page: 446 year: 2010 article-title: A lexicon for endoscopic adverse events: report of an ASGE workshop publication-title: Gastrointest Endosc – volume: 41 start-page: 1018 year: 2009 article-title: Process quality and incidence of acute complications in a series of more than 230 000 outpatient colonoscopies publication-title: Endoscopy – volume: 97 start-page: 1601 year: 2007 article-title: The UK colorectal cancer screening pilot: results of the second round of screening in England publication-title: Br J Cancer – volume: 126 start-page: 1247 year: 2004 article-title: Wide variation in adenoma detection rates at screening flexible sigmoidoscopy publication-title: Gastroenterology – volume: 85 start-page: 969 year: 1990 article-title: A prospective study of colonic neoplasms in asymptomatic patients with an age related risk publication-title: Am J Gastroenterol – volume: 41 start-page: 941 year: 2009 article-title: Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy publication-title: Endoscopy – volume: 329 start-page: 133 year: 2004 article-title: Results of the first round of a demonstration of a pilot of screening for colorectal cancer in the United Kingdom publication-title: BMJ |
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| Snippet | ObjectivesColonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer... Objectives Colonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer... Colonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer Screening... OBJECTIVES: Colonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer... |
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| SubjectTerms | Accreditation Adenoma - diagnosis Adenoma - epidemiology adverse events Aged Biological and medical sciences chromoendoscopy colonic adenomas colonic polyps Colonoscopy Colonoscopy - adverse effects Colonoscopy - methods Colonoscopy - standards colorectal adenomas Colorectal cancer colorectal cancer screening colorectal carcinoma Colorectal Neoplasms - diagnosis Colorectal Neoplasms - epidemiology Data collection Digestive system. Abdomen Early Detection of Cancer - methods Endoscopy epidemiology Female Gastroenterology. Liver. Pancreas. Abdomen helicobacter therapy Humans IBD clinical Incidence inflammatory bowel disease Intubation Investigative techniques, diagnostic techniques (general aspects) iron deficiency Male Medical sciences Medical screening Middle Aged Occult Blood Patient safety quality Quality control Quality Indicators, Health Care screening State Medicine therapeutic endoscopy Tumors United Kingdom |
| Title | Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme |
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