Scope to improve: a multi-centre audit of 16 064 colonoscopies looking at caecal intubation rates, over a 2-year period

Verma, Ajay; McGrath, N; Bennett, Paula; Caestecker, J De; Dixon, Andrew; Eaden, Jayne; Wurm, Peter; Chilton, Andrew

doi:10.1136/flgastro-2012-100118

Cited by 8 publications

(6 citation statements)

References 9 publications

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“…This study’s results demonstrated that the CIR in symptomatic patients is lower than in individuals undergoing colorectal cancer screening. This finding is in line with previous studies 7,12 ; Verma et al. found that the CIRs for screening colonoscopists were higher than for non-screening colonoscopists, and this accounted for the observed difference in CIRs between screening and symptomatic patient groups 12 ; however, we demonstrated that even when looking at just screening colonoscopists, there is still a persistent difference in CIRs between these two groups of patients.…”

Section: Discussionsupporting

confidence: 93%

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Variation in caecal intubation rates between screening and symptomatic patients

Nagrath

Phull

2014

UEG Journal

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Section: Discussionsupporting

confidence: 93%

“…7,12 The aim of this study was to compare colonoscopists' performance, as assessed by CIR in symptomatic patients compared to individuals undergoing colonoscopy for colorectal cancer screening.…”

Section: Introductionmentioning

confidence: 99%

Variation in caecal intubation rates between screening and symptomatic patients

Nagrath

Phull

2014

UEG Journal

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“…Of real concern are operators carrying out less than 100 procedures per year; they did not meet the desired CIR quality standard, and performed 4793 colonoscopies 2. We would suggest that this reflects a wider experience in the English health service and needs to be addressed.…”

Section: Discussionmentioning

confidence: 96%

“…The measurement of quality of colonoscopy has been in the vanguard of quality improvement, with two large UK based audits describing key performance standards 1 2. The Joint Advisory Group on Gastrointestinal endoscopy (JAG), an inter-collegiate body responsible for standards, quality and training, has issued guidance for caecal intubation rates (CIR) of 90% or higher on an intention-to-colonoscope basis 3.…”

Section: Introductionmentioning

confidence: 99%

Correlation of caecal intubation rate to volume: colonoscopists should undertake at least 120 procedures per year

Verma

Dixon

Chilton

2013

Frontline Gastroenterol

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IntroductionThe measurement of the quality of colonoscopy has been in the vanguard of quality improvement. The Joint Advisory Group on Gastrointestinal endoscopy (JAG) has issued guidance for practitioners to achieve caecal intubation rates (CIR) of ≥90% and to undertake ≥100 colonoscopies per annum. The British Society of Gastroenterology National Colonoscopy Audit published in 2012-2013 demonstrated a combined CIR of 92.3%. In 2012, we published data from 16 064 colonoscopies showing a combined CIR of 90.57%-both meeting JAG's standard. Analysis of our audit looked at the relationship of volume and outcome. CIR of operators performing ≥100 procedures per annum was 91.76%; those performing <100 was 87.77%. The 2-year data we collected involved 120+ operators. This provided an opportunity to study the correlation between volume and CIR in detail. Methods We analysed 129 operator records who had undertaken 20-399 procedures per annum (total 12 594). Each operator's volume was plotted against CIR as individuals and groups of operators undertaking a similar annual volume. 9859 procedures (78.3%) were performed by operators undertaking 20-199 procedures per annum (120 operators); this subgroup was further analysed. Results When plotting individuals and groups of individuals who have undertaken a similar annual volume against CIR, the trend-lines cross a 90% CIR at a volume of 120-125 procedures. The subgroup analysis showed the trend-line crossing at 110-120 procedures. Conclusions This detailed analysis of 12 594 colonoscopies over 2 years suggests that JAG should advise operators to undertake ≥120 procedures per annum to support the quality standard for CIR of ≥90%.

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“…The most recent multicentre audit of 16 064 colonoscopies by Verma et al 3 demonstrated the impact that this programme has had. Data over a 2-year period from 2008 to 2009 were collected from six hospitals, 120 endoscopists and 16 064 colonoscopies, demonstrating a marked improvement in the CIR to 90.57%.…”

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confidence: 99%

Should patients expect their colonoscopy to reach the standards experienced by bowel cancer screening patients?

Banks

2012

Frontline Gastroenterol

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OPINION 122Although the administrative burden of the endoscopy quality improvement programme is immense, these measures have undoubtedly had a very positive impact on patient-centred endoscopic care in the UK.The first large UK audit of colonoscopy standards undertaken by Bowles et al revealed a caecal intubation rate (CIR) of only 56.9% from 9223 procedures. 1 The potential implications of this poor national performance were significant. One of the most important indications for colonoscopy is to prevent colorectal cancer deaths by detecting cancer at a curative stage or removing potentially cancerous polyps. Low CIRs are associated with colorectal cancer in patients who have undergone a colonoscopy in the past; 2 therefore, the number of 'missed' cancers was likely to be unacceptably high in the UK at the time of this audit. The audit also highlighted that improvements needed to be made before the introduction of colorectal screening.Following this audit, the Joint Advisory Group on Gastrointestinal Endoscopy introduced a quality improvement programme involving training standards, peer review and the implementation of the Global Rating Scale. The most recent multicentre audit of 16 064 colonoscopies by Verma et al 3 demonstrated the impact that this programme has had. Data over a 2-year period from 2008 to 2009 were collected from six hospitals, 120 endoscopists and 16 064 colonoscopies, demonstrating a marked improvement in the CIR to 90.57%. This is a remarkable achievement in such a short period of time.As one would expect, the CIR was greater for bowel cancer screening colonoscopies than for non-screening colonoscopies (97.71% vs 88.31%). This difference is likely to be related to a variety of factors including the skill of the screening colonoscopists who are required to pass a summative assessment test before undertaking screening lists, but also the extended time allocated for each screening colonoscopy allowing for a longer withdrawal time, quality of bowel preparation, patient selection and fitness and nurse preassessment. A very clear outcome of the study was that operators undertaking less than 100 procedures per year were less likely to achieve a CIR greater than 90%. Furthermore, non-gastroenterologist/surgeons failed to reach the caecum in nearly 22% of cases. The operator skill therefore plays a clear role in the success of the procedure and is supported by circumstantial evidence from earlier studies. Haseman et al demonstrated that colorectal cancers were more likely to be missed by non-gastroenterologists than gastroenterologists. 4 In this study, if the caecum was reached, the miss rates were equal, further supporting the importance of a complete colonoscopy.In addition to the CIR, there are other evidence based markers of diagnostic quality, including adenoma detection rate (ADR), polyp detection rate, colonoscopy withdrawal time, CIR, rectal retroversion rate, polyp retrieval rate and bowel preparation. These markers are routinely collected from screening colonoscopies by a dedicated nurse ...

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Scope to improve: a multi-centre audit of 16 064 colonoscopies looking at caecal intubation rates, over a 2-year period

Abstract: Objective Colonoscopy is the 'gold standard' assessment for large bowel mucosal pathology, but a complete examination is essential.

Cited by 8 publications

References 9 publications

Variation in caecal intubation rates between screening and symptomatic patients

Variation in caecal intubation rates between screening and symptomatic patients

Correlation of caecal intubation rate to volume: colonoscopists should undertake at least 120 procedures per year

Should patients expect their colonoscopy to reach the standards experienced by bowel cancer screening patients?

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