Colonoscopic surveillance in Inflammatory Bowel Disease: Improving the service for our patients

Poster Download

Background

NICE guidelines exist for how patients with IBD should be surveyed for developing colorectal cancer as they are a high risk group. Recent data from the post colonoscopy colorectal cancer (PCCRC) project group suggests we are still missing cancers in these patients. As a Trust we are not following the NICE guidelines. We hope by improving our services to meet the guidelines, this will reduce our PCCRC rates.

Aim

30% of eligible IBD patients are offered a surveillance colonoscopy that meets the NICE guidelines in the next 6 months.

Method

Firstly we process mapped the current pathway for our IBD patients who are eligible for colonoscopic surveillance for colorectal cancer.

We needed to develop a way of monitoring our progress as there was no way of collecting audit data for these procedures.

From our process mapping we identified the following areas for change:

• Endoscopy bookings staff were not aware of the extra time required to carry out a surveillance colonosocopy therefore they were being booked with inadequate time on the lists
• The bookings staff were not always able to identify which requests were for IBD surveillance
• No database or recall system for patients eligible for colonoscopy surveillance
• Procedures were not being booked onto appropriate colonoscopists lists

Results

• We changed the national endoscopy reporting system so we now get monthly reports on all IBD surveillance procedures carried out within the Trust
• We changed our system of validating endoscopy requests so that it is now clear which requests are for IBD surveillance
• We have set up a database that identifies which patients are due for surveillance colonoscop

Implications

• Changing a national computer system is challenging and time-consuming. Relying on an outside agency for your QI project to move forward can lead to significant delays
• Gaining buy-in from different departments who have conflicting priorities is challenging. We have tried to address this by having members of each department on our project team
• If we are able to set up a successful system there will be scope to spread this to other hospitals within the region.