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PROLONGED WAIT TIMES FOR COLONOSCOPY IN CANADA: THE CANADIAN ASSOCIATION OF GASTROENTEROLOGY (CAG) ENDOSCOPY QUALITY INITIATIVE (EQI) PILOT PROJECT

D Armstrong1, D MacIntosh2, R Hollingworth3, Y Chen1, J Cabrera4, S Daniels5, R Bridges4, P Sinclair5, S Gittens6, C Dube4

1Division of Gastroenterology, McMaster University, Hamilton, Ontario; 2Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia; 3Division of Gastroenterology, The Credit Valley Hospital, Mississauga, Ontario; 4Division of Gastroenterology, University of Calgary, Calgary, Alberta; 5Canadian Association of Gastroenterology, Oakville, Ontario; 6ECD Solutions, Atlanta, Georga, USA
Aims:
Wait times (WT) for patients with gastrointestinal (GI) complaints exceed published recommendations (Can J Gastro 2006;20:411, Can J Gastro 2008;22:161). Maximal WT recommended by CAG include: (a) <2 weeks: features of active inflammatory bowel disease (IBD), (b) <2 months: bright red rectal bleeding, positive fecal occult blood test (FOBT), chronic constipation or diarrhea, (c) <6 months: screening colonoscopy.
Aim: To evaluate discrepancies between recommendations and practice for colonoscopy WT in Canada.
Methods: Endoscopists at 13 Canadian centres undertook the EQI, including a practice audit (PA) to record data on colonoscopies performed over a period of at least 2 weeks. Data were collected at the time of procedure using data collection software (ReForm XT, Goanyware Software, Tulsa, OK) on a smart phone (Treo 650, Palm Inc, Mississauga, ON), downloaded immediately to a secure website and then presented on a secure website (ECD solutions, Atlanta, GA) for inspection by participants, consistent with PA requirements. The primary outcome was the total WT from referral to colonoscopy (WT_T), shown as median, 75th and 90th centiles.
Results: Since February 2008, 45 endoscopists (BC 3, AB 6, SK 14, MB 3, ON 8, QC 6, NS 5; 34 GIs and 11 surgeons) have reported on 822 colonoscopies. The median WT_T (all evaluable data, n=754) was 147 days (261, 397). For patients investigated for an abnormal symptom or finding, WT_T=116 days (217, 307); for those awaiting screening, WT_T=159 days (291, 396).
Conclusions: Median WT for patients with positive FOBT or family history of colon cancer fall within recommended times but WT for investigation of IBD, GI bleeding and diarrhea markedly exceed recommendations.
Wait times for many patients referred for colonoscopy exceed the CAG-recommended maxima. Wait times for FOBT-positive patients are somewhat shorter but access to care remains unacceptably prolonged for those with symptoms of serious GI disease. The EQI program provides a valuable, point-of-care data collection tool to evaluate delivery of care for patients with digestive diseases.
Indication N Total Wait Time = WT_T (days) Median (75th / 90th centile)
(a) IBD flare 25 102 (170/531)
(b) Gastrointestinalblood loss 169 110 (189/294)
(b) Positive FOBT 22 34 (84/205)
(b) Diarrhea 87 132 (221/344)
(c) Family history of colon cancer 150 163 (329/480)

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