Completion rate to caecum as a quality measure of colonoscopy in a district general hospital

Abstract

Objective Published colonoscopy completion rates vary substantially and audits suggest they often fall short of the 85% completion rate to caecum considered acceptable by some authorities. We audited colonoscopy completion rates in our unit and aimed to investigate reasons for failure. Methods We analysed all colonoscopies, including those by trainees, performed in a district general hospital over a 16-month period. Reasons for failure to complete were investigated and alterations to working practices made where necessary. Results The unit had an 89.1% completion rate overall (95% CI 87–92%) with rates varying from 75% to 97% for individuals. Colorectal carcinomas were detected in 3.9% of all colonoscopies of which 17% occurred proximal to the caecum and 16% in the ascending colon. Working practices in those endoscopists felt not to be meeting targets were altered and a re-audit confirmed a trend towards improvement in those individuals. Using these data we also identified a definite learning curve in trainees, with at least 40 procedures required to meet the target of 85% completion rate to caecum. Conclusion In a District General Hospital high standards of colonoscopy can be achieved. Reasons for failure to complete colonoscopy to the caecum are many and often they are beyond the control of the colonoscopist (e.g. poor preparation, obstructing lesion). Colonoscopy to the caecum is not always necessary and is not a good measure of the quantity of colonic mucosa visualized. We have reservations with regard to using this target alone as a measure of quality.