The Colonoscopy Clinical Care Standard has been endorsed by ten key professional organisations and colleges including the Royal Australian College of Physicians (RACP), the Gastroenterological Society of Australia (GESA), the Royal Australasian College of Surgeons (RACS) and the Colorectal Surgical Society of Australia and New Zealand (CSSANZ).
The development of the Colonoscopy Clinical Care Standard was recommended as part of the Safety and Quality Model for Colonoscopy and was funded by the Australian Government Department of Health. It was developed in collaboration with a multidisciplinary expert Topic Working Group including clinicians and consumers. Implementing clinical care standards helps health service organisations to meet the requirements of the National Safety and Quality Health Service (NSQHS) Standards for accreditation.
Colonoscopy refers to the examination of the entire large bowel using a camera on a flexible tube, or colonoscope. It is often performed to look for possible bowel cancer, either in people with symptoms and signs of bowel disease, or those with an increased risk of bowel cancer. It may also be used to help diagnose the cause of symptoms in conditions such as inflammatory bowel disease.
High quality colonoscopy is critical to the early detection and treatment of bowel cancer. Bowel cancer is the second most common cancer diagnosed in both men and women in Australia, which has one of the highest rates of bowel cancer in the world. Evidence-based guidelines describe when colonoscopy should be used and how frequently testing should occur, according to the patient’s presenting symptoms, history and risk.
In Australia, screening for bowel cancer usually involves a faecal occult blood test (FOBT). Participants with a positive screening result (indicated by blood in the stool sample), are advised to discuss further diagnostic assessment with their primary health care provider – usually this will be a colonoscopy. Faecal occult blood tests are provided for free to eligible Australians aged 50 to 74, through the National Bowel Cancer Screening Program (NBCSP) or when a doctor requests a test through Medicare. For people whose personal and/or family health history puts them at significantly higher than average risk of bowel cancer, screening is by regular colonoscopy.
The quality of colonoscopy is also important for minimising the risk of complications from the procedure. Complications associated with colonoscopy include:
- Risks of the procedure itself such as perforation and bleeding
- Risks associated with bowel preparation including dehydration and electrolyte imbalances which can be serious
- Complications arising from sedation or anaesthesia
While the risk of complications is relatively small, a large number of people undergo colonoscopy some of whom will have multiple colonoscopies.
More than 900,000 colonoscopies are performed in Australia annually. Despite the large number of procedures performed annually, the Australian Atlas of Healthcare Variation found considerable geographic variation in diagnostic colonoscopy, with up to a 30-fold variation in rates of MBS funded colonoscopies across Australia.
Colonoscopy Clinical Care Standard
This resource provides guidance to consumers, clinicians and health services on the care recommended in the Colonoscopy Clinical Care Standard. Implementing clinical care standards helps health service organisations to meet the requirements of the National Safety and Quality Health Service (NSQHS) Standards for accreditation. Find out more at the NSQHS Standards website.
The Colonoscopy Clinical Care Standard will be implemented in public and private hospitals and day procedure centres nationally as part of the National Safety and Quality Health Service (NSQHS) Standards (2nd edition). The Commission is engaging with primary care, the private healthcare sector and jurisdictions to undertake piloting of the Standard across the sectors.
Use these resources to implement and promote the Colonoscopy Clinical Care Standard to health services, clinicians, patients and their carers.
Watch an interview with an expert - Professor Anne Duggan, Co-chair of the Colonoscopy Topic Working Group.
This resource provides a set of suggested indicators to assist with local implementation of the Colonoscopy Clinical Care Standard. Clinicians and health services can use the indicators to monitor implementation of the quality statements, and support improvements as needed.
The indicators described in this clinical care standard are intended to align with the Safety and Quality model for Colonoscopy and the performance indicators for certification and recertification indicators being developed by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy (CCRTGE).
Credentialing, certification and re-certification of colonoscopists
The CCRTGE has offered a program for recognising training in endoscopy and colonoscopy for some years.
Recently, GESA introduced a voluntary triennial re-certification program in colonoscopy, designed to support practitioners to:
- Maintain their expertise in colonoscopy
- Continue to develop their skills through subsidised training opportunities
- Increase safety standards and the quality of care being delivered to patients.
In May 2017, the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) endorsed the GESA voluntary recertification program for its members. The standards and quality indicators supported by the GESA and CSSANZ are expected to form the basis of the specifications for the re-certification of medical colonoscopists.
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