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

Area of Science:

• Gastroenterology
• Health Services Research
• Quality Improvement Science

Background:

• Colonoscopy completion rates in the UK were suboptimal, with a large audit showing only 57% caecal intubation when stringent criteria were applied.
• National targets mandate a 90% caecal intubation rate for colonoscopies.
• Limited information existed on practical strategies for improving colonoscopy completion rates at the unit and operator level.

Purpose of the Study:

• To implement and evaluate a quality improvement program aimed at increasing colonoscopy completion rates in a UK hospital.
• To identify and address the key factors contributing to failed colonoscopies.

Main Methods:

• A quality improvement program involving two audit cycles was conducted between 1999 and 2002.
• Changes in practice were informed by audit results and staff input, focusing on appointment length, inpatient bowel preparation for frail patients, and operator-specific colonoscopy allocation.
• Colonoscopy completion rate was the key measure for improvement.

Main Results:

• The initial colonoscopy completion rate was 60%.
• Following the first audit cycle, the completion rate improved to 71%.
• After the second audit cycle, the completion rate reached 88%, approximating the 90% audit standard, with a final adjusted rate of 94%.

Conclusions:

• Achieving national colonoscopy targets is feasible in a UK general hospital setting.
• Strategies such as extending appointment times, dedicated inpatient bowel preparation for frail patients, and optimizing colonoscopy allocation to skilled operators are effective.
• This study provides a practical model for improving colonoscopy quality and patient care.