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QUALITY INDICATORS IN COLONOSCOPY: EXPERIENCE AT A CANADIAN ACADEMIC CENTRE
RK Berger, SE Gruchy, K Crawford, DG MacIntosh
Division of Gastroenterology, Dalhousie University, Halifax, NS
Colonoscopy is a diagnostic and therapeutic tool used to screen for adenomatous polyps and colorectal cancer. Cecal intubation and withdrawal times greater than 6 minutes correlate with higher rates of adenoma detection. Recent guidelines recommend documentation of quality indicators including cecal intubation rates, visualization of anatomic landmarks and withdrawal time. We reviewed current practice at our institution.
METHODS: All colonoscopies performed by gastroenterologists and general surgeons at the QE II Health Sciences Centre in Halifax were prospectively reviewed from April to September 2007. The primary outcome was cecal intubation rate. Secondary measures included documentation of procedure indication, withdrawal time and visualization of cecal landmarks. Dictated procedure reports were used for data collection.
RESULTS: During the study period, 1281 colonoscopies were completed. Indications for colonoscopy were 20.2% screening, 23.9% surveillance and 55.9% diagnostic cases. The overall cecal intubation rate was 87.9%. Cecal intubation increased to 92.2% of combined screening/surveillance colonoscopies and 93.8% of screening colonoscopies only. The overall Task Force adjusted cecal intubation rate was 92.2%.
In 60.3% of completed colonoscopies, cecal intubation was appropriately documented with anatomic landmarks identified by terminal ileal intubation or visualization of the ileocecal valve and appendiceal orifice (N=1126). Withdrawal time was recorded in 27.0% of completed cases. This increased to 38.3% for screening colonoscopies (N=243). Overall, the mean withdrawal time was 10 minutes (SD=4.5min).
Discussion: At our centre, cecal intubation rates meet current guidelines. However, appropriate documentation of visualization of anatomic landmarks is inconsistent. Withdrawal times are not routinely documented in the dictated procedure report. Documentation of quality indicators during colonoscopy needs to be improved at our institution.