High quality colonoscopy in a low volume unit; is it achievable?

Abstract 

Background and study aims

Colonoscopy is a technically demanding procedure with potential for harm if performance is poor. Bolak Eldakror Hospital is a secondary-care governmental hospital in Giza, Egypt with an average colonoscopy volume of 28 procedures per year. Our aim was to determine whether a high standard of practice could be achieved in our unit by instituting a rigorous quality assurance programme in spite of a low colonoscopy volume (<50 colonoscopies per year). We assessed the quality of our colonoscopic service with the goal of improving performance.

Patients and methods

The crude completion rate was 50% in 2003. The main reasons for failure of completion were operator inexperience, poor patient tolerance and inadequate bowel preparation. Changes were instituted to improve performance. We assessed the quality of our colonoscopic service prospectively over a period of 6years. Colonoscopy completion rates and patient discomfort were considered to be the key measures for improvement. A total of 168 patients undergoing colonoscopies from the year 2004 to 2009 were evaluated.

Results

The colonoscopy completion rates improved consistently. The crude completion rate improved from 52% in 2004 to 94% in 2009. The adjusted completion rate improved from 60% in 2004 to 100% in 2009. There were no procedure-related complications. The percentage of patients who experienced moderate or severe pain during colonoscopy was 50% in 2004, increased to 72% in 2007 and improved to 27% in 2009.

Conclusion

A high standard of colonoscopy can be achieved in endoscopy units with a low colonoscopy volume by the rigorous application of quality assurance measures.