• Australian Commission on Safety and Quality in Health Care, Standard 11/09/2018
• Health, Standard 26/03/2019

The Australian Commission on Safety and Quality in Health Care has produced these indicators to assist with local implementation of the Colonoscopy clinical care standard (ACSQHC 2018).

The Colonoscopy clinical care standard relates to the care of adults undergoing colonoscopy for screening, diagnosis, surveillance, or treatment. It covers the period from when a patient is referred for consideration of colonoscopy through to discharge including planning for follow-up care. The Colonoscopy clinical care standard is relevant to the care provided in primary and acute healthcare settings, including general practice, and public and private hospitals including day procedure services.

A clinical care standard is a small number of quality statements that describe the clinical care that a patient should be offered for a specific clinical condition. The indicators included in this specification are a tool to support local clinical quality improvement and may be used to support other quality assurance and peer review activities. The indicators have been specified to align with the performance indicators that form part of the certification and recertification processes led by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy (CCRTGE), a national body comprising representatives of the Royal Australasian College of Physicians (RACP), the Gastroenterological Society of Australia (GESA), and the Royal Australasian College of Surgeons (RACS).

The quality statements that are included in the Colonoscopy clinical care standard are as follows:

1. Initial assessment and referral. When a patient is referred for consideration of colonoscopy, the referral document provides sufficient information for the receiving clinician to assess the appropriateness, risk and urgency of consultation. The patient is allocated an appointment according to their clinical needs.
2. Appropriate and timely colonoscopy. A patient is offered timely colonoscopy when appropriate for screening, surveillance, or the investigation of signs or symptoms of bowel disease, as consistent with national evidence-based guidelines. Decisions are made in the context of the patient’s ability to tolerate the bowel preparation and colonoscopy, and their likelihood of benefit. If colonoscopy is not appropriate, the receiving clinician advises the patient and their referring clinician of alternate recommended management.
3. Informed decision making and consent. Before starting bowel preparation, a patient receives comprehensive consumer-appropriate information about bowel preparation, the colonoscopy and sedation or anaesthesia. They have an opportunity to discuss the reason for the colonoscopy, its benefits, risks, financial costs and alternative options before deciding to proceed. Their understanding is assessed, and the information provided and their consent to sedation, colonoscopy and therapeutic intervention is documented.
4. Bowel preparation. A patient booked for colonoscopy receives a bowel preparation product and dosing regimen individualised to their needs, co-morbidities, regular medicines and previous response to bowel preparation. The importance of good bowel preparation for a quality colonoscopy is discussed with the patient. They are provided with consumer-appropriate instructions on how to use the bowel preparation product and their understanding is confirmed.
5. Sedation. Before colonoscopy, a patient is assessed by an appropriately trained clinician to identify any increased risk, including cardiovascular, respiratory or airway compromise. The sedation is planned accordingly. The risks and benefits of sedation are discussed with the patient. Sedation is administered and the patient is monitored throughout the colonoscopy and recovery period in accordance with Australian and New Zealand College of Anaesthetists guidelines.
6. Clinicians. A patient’s colonoscopy is performed by a credentialed clinician working within their scope of clinical practice, who meets the requirements of an accepted certification and recertification process. Sedation or anaesthesia and clinical support are provided by credentialed clinicians working within their scope of clinical practice.
7. Procedure. When a patient is undergoing colonoscopy their entire colon – including the caecum – is examined carefully and systematically. The adequacy of bowel preparation, clinical findings, biopsies, polyps removed, therapeutic interventions and details of any adverse events are documented. All polyps removed are submitted for histological examination.
8. Discharge. Following recovery and before discharge, the patient is advised verbally and in writing about the preliminary outcomes of the colonoscopy, the nature of any therapeutic interventions or adverse events, when to resume regular activities and medication, and arrangements for medical follow-up. The patient is discharged into the care of a responsible adult when it is safe to do so.
9. Reporting and follow-up. The colonoscopist communicates the reason for the colonoscopy, its findings, any histology results and recommendations for follow-up in writing to the general practitioner, any other relevant clinician and the patient, and documents this in the facility records. Recommendations for surveillance colonoscopy, if required, are consistent with national evidence-based guidelines. If more immediate treatment or follow-up is needed, appropriate arrangements are made by the colonoscopist.