Impact of UK Colorectal Cancer Screening Pilot on hospital diagnostic services.
OBJECTIVE
To determine the impact of the UK Colorectal Cancer Screening Pilot on hospital services involved in the diagnosis of colorectal cancer (predominantly colonoscopy, double contrast barium enema and pathology).


METHODS
Routine data from seven hospitals at two sites within Scotland and England participating in the Pilot were collected on activity levels and waiting times for key hospital services (GI medicine, surgery and radiology), plus questionnaire survey data from hospital consultants.


RESULTS
Hospital colonoscopy activity increased by 31 per cent in Scotland and 21 per cent in England due to the investigation of faecal occult blood testing (FOBt) positive subjects. The demand for symptomatic (non-screening) colonoscopy also increased. Pilot-generated activity was less than predicted for barium enema services (maximum 3 per cent increase in service volume) but greater than expected for pathology, with approximately 200 specimens/month generated. Out-patient review of Pilot colonoscopy patients and associated administrative duties added substantially to overall GI service workload, but quantification was limited by the quality of routinely available data. There was a wide discrepancy in colonoscopy waiting times between screened and symptomatic patients, with predominantly longer waits for symptomatic patients: otherwise the quality of colonoscopy services appeared to improve. In any future national screening programme, follow-up of patients with adenomas will result in a further increase of 28 per cent in the number of colonoscopies generated (over and above colonoscopy for FOBt-positive subjects), adding substantially to overall workload.


CONCLUSIONS
During the planning of any successful national colorectal cancer screening programme, careful consideration must be given to the wider aspects of workload associated with screening, as well as to the implementation of appropriate hospital data collection systems.
Price
Jacqueline
J
Department of Community Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK. Jackie.Price@ed.ac.uk
Campbell
Christine
C
Sells
Joanne
J
Weller
David
D
Campbell
Harry
H
Kenicer
Margaret
M
Dunlop
Malcolm
M
D000368:Aged; D001466:Barium Sulfate; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003954:Diagnostic Services / Q000706:statistics & numerical data*; D004733:Enema / Q000706:statistics & numerical data; D004739:England; D006284:Health Plan Implementation; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration / Q000706:statistics & numerical data*; D008875:Middle Aged; D010865:Pilot Projects; D015397:Program Evaluation; D012606:Scotland; D014850:Waiting Lists; D016526:Workload
D001466:Barium Sulfate