Rapid Access Colonoscopy: Faecal Occult Blood Test

This project designed and implemented a rapid access colonoscopy service for positive faecal occult blood test (+FOBT) referrals in Hunter New England Local Health District (HNELHD).

Aim

To reduce the wait time for colonoscopy and colorectal cancer diagnosis in HNELHD .

Benefits

• Improves the early detection of polyps, which saves lives and reduces the need for costly cancer treatment.
• Improves access and service delivery for patients with a +FOBT who require a colonoscopy.
• Delivers safe, evidence-based, effective and appropriate healthcare for +FOBT patients.
• Enhances the efficiency of resources and services across the local health district.
• Reduces unnecessary variation in clinical practice associated with endoscopy waiting lists for +FOBT patients.

Background

A faecal occult blood test (FOBT) is a simple test that looks for the early signs of bowel cancer. It can be completed at home and involves taking a minuscule sample from two separate bowel motions (faeces) using a test kit. Samples are then sent to a laboratory for testing. FOBTs look for the presence of blood in bowel motions. If blood is detected, the +FOBT patient is referred to a specialist and asked to have a colonoscopy.

The introduction of the National Bowel Cancer Screening Program increased the number of +FOBTs in HNELHD and as a result, there were major delays to colonoscopy and colorectal cancer diagnosis services in the region. Following an audit of clinical data and information from focus groups, it was determined that there should be one streamlined process for rapid access colonoscopies.

Implementation

• The project team identified key stakeholders and met with them to discuss challenges and potential changes to improve access to colonoscopies.
• A process for rapid access colonoscopies with phone screening was developed, with suitable patients proceeding to a direct access (DA) colonoscopy and bypassing outpatient clinics. Those not suitable were processed via an expedited clinic process (ECP).
• The allocation to colonoscopy lists was based on patient factors, colonoscopy wait list size and time.
• A HealthPathway for colorectal and +FOBT referrals was developed, including a standardised referral form and a central referral point for all patients.
• A flowchart based on National Health and Medical Research Council Guidelines was developed to help general practitioners (GPs) conduct FOBTs .
• Education sessions were delivered to GPs in their clinics, on the topics of FOBT screening and polyp surveillance.
• Central Coast Local Health District, the Cancer Institute and the NSW Bowel Program are looking to replicate this project.
• The rapid access methodology may be expanded to include other criteria for colonoscopies in the future and can be transferrable to any procedure that is performed as a screening test that requires technical investigation.

Project status

• Sustained - the initiative has been implemented and is sustained in standard business.

Key dates

• Pilot project start: December 2013
• Pilot project finish: June 2014
• Full implementation: July 2014
• Cost-benefit analysis: February 2016

Implementation sites

• Calvary Mater Hospital
• John Hunter Hospital
• Belmont Hospital

Partnerships

• Hunter Medicare Local
• Calvary Mater Hospital
• Cancer Institute NSW

Results

• There was a reduction in the time from GP referral to colonoscopy, with the median time reduced by 38 days (46%) for DA and 19 days (23%) for ECP .
• The demand for outpatient clinic appointments was reduced by the phone screening service, with 466 patients assessed and 298 (64%) not requiring an outpatient appointment.
• The standardised referral process reduced duplicate referrals across specialties and local health districts, resulting in increased productivity and efficiency for staff.
• Results from 209 DA and 71 ECP colonoscopies (280 patients) included 21 adenocarcinomas (7.5%), 121 adenomas (43.25%) and 138 normal / no neoplasia (49.25%).
• Outcomes for patients with polyps were recorded and followed up to ensure cancer treatment occurred.
• There have been no adverse events since implementation of the project.
• Plans for future evaluation include a detailed understanding of how this service is being used by GPs .
• A cost-benefit analysis is currently being undertaken by Cancer Services.

Awards

• 2015 NSW Health Awards Finalist – Collaborative Team

Lessons learnt

We learned the importance of doing background research and making sure all teams are involved in the process, as there are often more stakeholders than you may think.

Contact

Donna Gillies
Clinical Nurse Consultant
Hunter New England Local Health District
Phone: 02 4921 4659 or 02 4921 4805
donna.gillies@hnehealth.nsw.gov.au