Quality improvement programme to achieve acceptable colonoscopy completion rates: prospective before and after study

doi:10.1136/bmj.329.7467.665

BMJ 2004;329:665-667 (18 September), doi:10.1136/bmj.329.7467.665

Quality improvement report

Quality improvement programme to achieve acceptable colonoscopy completion rates: prospective before and after study

Jennifer E Ball, pre-registration house officer¹, Jane Osbourne, sister, endoscopy department¹, Sarah Jowett, specialist registrar¹, Mike Pellen, PRHO¹, Mark R Welfare, senior lecturer¹

¹ North Tyneside General Hospital, North Shields NE29 8NH

Correspondence to: M R Welfare doctormarkw{at}aol.com

Problem A large audit of colonoscopy in the United Kingdom showedthat the unadjusted completion rate was 57% when stringent criteriafor identifying the caecum were applied. The caecum should bereached 90% of the time. Little information is available onwhat units or operators need to do to improve to acceptablelevels.

Design Quality improvement programme using two completed cyclesof audit.

Setting Endoscopy department in a university linked generalhospital in northeast England.

Key measures for improvement Colonoscopy completion rate.

Strategy for change Two audit cycles were completed between1999 and 2002. Changes to practice were based on results ofaudit and took into account the opinions of relevant staff.Lack of time for each colonoscopy, poor bowel preparation, especiallyin frail patients, and a mismatch between number of colonoscopiesdone and completion rate for individual operators were responsiblefor failed colonoscopies. Appropriate changes were made.

Effects of change The initial crude colonoscopy completion ratewas 60%, improving to 71% after the first round of audit and88% after the second round, which approximates to the agreedaudit standard of 90%. The final adjusted completion rate was94%.

Lessons learnt Achievement of the national targets in a UK generalhospital is possible by lengthening appointments, admittingfrail patients for bowel preparation to one ward, and allocatingcolonoscopies to the most successful operators.

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