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


METHODS
Quality improvement programme using two completed cycles of audit.


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


METHODS
Colonoscopy completion rate.


METHODS
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.


RESULTS
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%.


CONCLUSIONS
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.
Ball
Jennifer E
JE
North Tyneside General Hospital, North Shields NE29 8NH.
Osbourne
Jane
J
Jowett
Sarah
S
Pellen
Mike
M
Welfare
Mark R
MR
D003113:Colonoscopy / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008485:Medical Audit; D011787:Quality of Health Care; D016896:Treatment Outcome; D006113:United Kingdom