Quality Improvement Reports

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

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7467.665 (Published 16 September 2004) Cite this as: BMJ 2004;329:665
  1. Jennifer E Ball, pre-registration house officer1,
  2. Jane Osbourne, sister, endoscopy department1,
  3. Sarah Jowett, specialist registrar1,
  4. Mike Pellen, PRHO1,
  5. Mark R Welfare, senior lecturer (doctormarkw{at}aol.com)1
  1. 1 North Tyneside General Hospital, North Shields NE29 8NH
  1. Correspondence to: M R Welfare
  • Accepted 23 June 2004


Problem A large audit of colonoscopy in the United Kingdom showed that the unadjusted completion rate was 57% when stringent criteria for identifying the caecum were applied. The caecum should be reached 90% of the time. Little information is available on what units or operators need to do to improve to acceptable levels.

Design Quality improvement programme using two completed cycles of audit.

Setting Endoscopy department in a university linked general hospital in northeast England.

Key measures for improvement Colonoscopy completion rate.

Strategy for change Two audit cycles were completed between 1999 and 2002. Changes to practice were based on results of audit and took into account the opinions of relevant staff. Lack of time for each colonoscopy, poor bowel preparation, especially in frail patients, and a mismatch between number of colonoscopies done and completion rate for individual operators were responsible for failed colonoscopies. Appropriate changes were made.

Effects of change The initial crude colonoscopy completion rate was 60%, improving to 71% after the first round of audit and 88% after the second round, which approximates to the agreed audit standard of 90%. The final adjusted completion rate was 94%.

Lessons learnt Achievement of the national targets in a UK general hospital is possible by lengthening appointments, admitting frail patients for bowel preparation to one ward, and allocating colonoscopies to the most successful operators.


  • North Tyneside General is part of Northumbria Healthcare Trust

  • Contributors JEB carried out the third phase of the audit, collated data, and contributed to drafts of the paper. JO was responsible for decision making and implementing the action plan from audit cycles and contributed to drafts of the paper. MP carried out the second phase of the audit and contributed to drafts of the paper. SJ was involved in data gathering and analysis for phase one of the audit and contributed to drafts of the paper. MRW oversaw all phases of the audit, including data gathering and action plans, collated all information, and contributed to drafts of the paper. MRW is the guarantor.

  • Funding None.

  • Competing interests None declared.

  • Ethical approval Not needed.

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