Primary content

Authors

D Gillies (Lead)

P Pockney

J Gani

R Foster

A Duggan

Aims

To reduce the median / mean time from GP referral to colonoscopy for public patients referred to the Greater Newcastle Sector (GNS) following a +FOBT.

Method

  1. To review and record current processes across 3 hospitals (GNS) and 2 specialties and make changes accordingly to improve time from GP referral to colonoscopy for +FOBT referrals who meet the NHMRC guidelines.
  2. Change Process: Employ a colorectal coordinator / project officer. Develop: a process for fast track (FT) colonoscopy, a screening tool for assessing patients for direct access (DA) colonoscopy (no endoscopist consultation), a standard phone conversation when screening patients, a standard bowel preparation and instruction sheet, a process to fairly allocate patients to endoscopist and hospital. Create a database to record information.

Results

Pre N=71 post N=111 patients, 75 progressed to DA colonoscopy, a further 4 were FT to colonoscopy.  26 patients were not suitable for DA: 11 (<50 or >75yrs), 4 recent colonoscopy (<18months), 11 complex medical conditions.  A further 6 had their colonoscopy in the private system. Median / mean days to colonoscopy pre:  82 (102), post change process:  DA 42 (46), FT 27 (31).  Pathology: 12% had a carcinoma, 33% had tubular adenomas or high risk sessile adenomas.

Implications

Multifaceted and systemised coordinated approach to processing +FOBT patients reducing the time to diagnosis and definitive treatment of colorectal cancer. The process changes introduced in our study would be adaptable to other institutions.