Screening to reduce or prevent bowel cancer requires expert endoscopists who look into the bowel and find cancers or signs that a patch of bowel (a polyp or adenoma) might develop into cancer.
This is a task that requires skills and experience. Finding enough polyps/adenomas that might develop into cancer is very important. This is referred to as the adenoma detection rate (ADR).
The NHS Bowel Cancer Screening Programme (BCSP) measures each clinician’s ADR performance and supports them if they are struggling. The programme has set an ADR minimum standard of 6.8%, with a target of 10%, using research from pilot studies.
Findings from these studies suggest that endoscopists get better at detecting adenomas as they perform more procedures, but it also suggests that once they achieve a certain level they do not improve. In some cases this level was below the minimum standard of 6.8%.
The Screening Quality Assurance Service (SQAS) has been working with screening centres to support endoscopists who are not reaching the minimum standard so that they find more adenomas and increase their ADR.
SQAS has used a variety of approaches to raise individual ADRs, including:
- regular monitoring of ADR data and sharing this information with screening centre clinical directors
- requesting action plans from screening centre clinical directors for endoscopists who are not reaching the minimum standard
- workshops that help endoscopists to understand how to improve their ADR – tips include taking longer to examine the bowel and withdraw the scope
Action plans to improve ADRs have included the following successful interventions:
- regular sharing and discussion of endoscopist’s key performance indicators with comparisons to other endoscopists’ data
- mentors or clinical directors observing endoscopists’ bowel scope procedure lists so they can pass on advice and support
- bowel scope endoscopists observing screening colonoscopy lists (within the BCSP) to appreciate the lengths colonoscopists go to in order to find adenomas and polyps
- further training for particular elements of practice such as polypectomy (the technique used to remove polyps)
The graphic below shows the improvement seen in 14 endoscopists who were below the minimum standard of 6.8% in January 2016. Following action plans and interventions, most endoscopists performed above the minimum ADR standard, with many performing above the national average.
To continue this improvement, we expect screening centre clinical directors to monitor the ADR performance of bowel scope screening endoscopists regularly. SQAS will continue to support this process.
Action plans should be agreed and submitted to SQAS for individuals whose ADR is below the minimum standard. These plans should detail the interventions to improve the clinician’s performance. Further support and advice is available by emailing SQAS at PHE.NationalQA@nhs.net.
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