| Quality indicator | Minimal standard | Aspirational target | Comment |
|---|---|---|---|
| Caecal intubation rate (CIR) (unadjusted) | 90% | 95% | Photographic proof of ileocaecal valve, terminal ileum, anastomosis or appendix orifice required in all cases |
| Adenoma detection rate (ADR) in general all patient population (not screening) | 15% | 20% | ADR is the quality standard. Given the difficulty in reporting ADR then polyp detection rate or polypectomy rate may be used where it has been demonstrated to reflect accurately ADR for that unit/clinician |
| Bowel preparation of sufficient diagnostic quality to not warrant repeat or alternative test | 90% | 95% | |
| Rectal retroversion rate | 90% | ||
| Colonoscopy withdrawal time (for negative procedures) | Mean of ≥6 min | Mean of ≥10 min | |
| Sedation level for age <70 Median total dose: ≤50 mg pethidine (≤100 μg fentanyl) ≤5 mg midazolam (or equivalent drugs) | Auditable outcome | ||
| Sedation level for age ≥70 Median total dose: ≤25 mg pethidine (≤50 μg fentanyl) ≤2 mg midazolam (or equivalent drugs) | Auditable outcome | ||
| Number of colonoscopies undertaken by endoscopist (or directly supervising trainee in room) per year | 100 | If numbers <150 then other key performance indicators, eg, CIR and ADR, should be scrutinised more closely and, if concerns, action taken | |
| Polyp retrieval rate | ≥90% | ||
| Tattooing of all lesions ≥20 mm and/or suspicious of cancer outside of rectum and caecum | Tattoo placed in 100% of cases | Tattoo according to trust policy | |
| Diagnostic biopsies for unexplained diarrhoea | Rectal biopsies taken in 100% of cases | Right and left colonic biopsies taken in 100% of cases | Aspiration should be that a minimum of two right and two left colon biopsies should be taken, but as minimum standard rectal biopsies should always be taken (unless there is a contraindication) |
| Post-colonoscopy colorectal cancer | Auditable outcome | All post-colonoscopy colorectal cancers diagnosed within 3 years of a colonoscopy should be reported as adverse events and each unit should have a policy for capturing post-colonoscopy colorectal cancer data | |
| Comfort level | Auditable outcome | Units should audit this and <10% of patients should have moderate or severe discomfort | |
| Overall colonoscopic perforation rate | <1 in 1000 | <1 in 3000 | |
| Diagnostic colonoscopic perforation rate | <1 in 2000 | <1 in 4000 | |
| Colonoscopic perforation rate where polypectomy performed | <1 in 500 | <1 in 1500 | |
| Colonoscopic perforation rate where dilatation performed | <3% (<1 in 33) | <1% (<1 in 100) | |
| Diagnostic flexible sigmoidoscopy (FS) perforation rate | <1 in 5000 | <1 in 10 000 | |
| Colorectal stenting perforation rate | <10% | <5% | |
| Post-polypectomy bleeding rate (intermediate severity or higher) | <1 in 200 | <1 in 1000 | |
| Unplanned admission rate | Auditable outcome; review every case | ||
| Use of reversal agents | Auditable outcome; review every case |
Auditable outcome—endoscopy units should audit these measures.
Additional recommendations
Management of polyps—all units should have a policy for management of polyps including a policy for dealing with large and large sessile polyps.
Tattoo policy—all units should have a policy for tattooing of polyps and cancers and should audit whether this is being followed.
Rectal examination should be performed at colonoscopy or before endoscopy. All units should audit practice.
Terminal ileal intubation—all units should audit practice and agree local policy.