Colon cancer is the commonest cancer in Australia. The Federal Gov. has recently accelerated the rollout of the National Bowel Cancer Screening Program to 2nd yearly after age 50 by 2018. We anticipate up to 1000 extra colonoscopies on the public system at NSLHD.

2. CNS Alison Andrews
Dr Ian Norton
Dept. of Gastroenterology
Royal North Shore Hospital
Expediting Colonoscopy for
Patients with a Positive
Faecal Occult Blood Test

3. Aim
To expedite colonoscopy for patients presenting
with a positive Faecal Occult Blood Test (FOBT)

4. Team members
Project team members:
Ian Norton
Alison Andrews, CNS

5. Background
• Colon cancer is the commonest cancer in Australia
• The Federal Gov. has recently accelerated the
rollout of the National Bowel Cancer Screening
Program to 2nd yearly after age 50 by 2018
• This will result in up to 100,000 extra colonoscopies
per year in Australia(DoHA – personal communication)
– We anticipate up to 1000-1500 extra colonoscopies on
the public system at NSLHD
• Ideally, colonoscopy should be within 30days
• 10% of these patients have cancer or advanced
neoplasia
• Colonoscopy relies on GP referral following a
+FOBT (“usual care pathway”)

6. Patient Experience
• Mr HC
• 60yr old male
• Seen in GI Out patients at RNSH
• Letter from GP: “+FOBT”
– Dated 9 months before he was seen in general GI
Clinic
– Colonoscopy 2 weeks later:

8. Patient Experience
• Mr HC
• 60yr old male
• Seen in GI Out patients at RNSH
• Letter from GP: “+FOBT”
– Dated 9 months before he was seen in general GI
Clinic
– Colonoscopy 2 weeks later:
• Normal

9. Colonoscopy
Private Patient
(or self-insure)
+FOBT
Invited to
Participate in
NBCSP
Private Rooms
(consultant
controls wait-list)
Out-patient
Clinic
Colonoscopy in
Public Hospital
Current status
Sees GP
(usual care
path)
Flow Chart of Process:
Public Patient

10. Colonoscopy
Private Patient
(or self-insure)
+FOBT
Invited to
Participate in
NBCSP
Private Rooms
(consultant
controls wait-list)
Out-patient
Clinic
Colonoscopy in
Public Hospital
Sees GP
(usual care
path)
Flow Chart of Process:
Public Patient

11. Colonoscopy
Private Patient
(or self-insure)
+FOBT
Invited to
Participate in
NBCSP
Private Rooms
(consultant
controls wait-list)
Out-patient
Clinic
Colonoscopy in
Public Hospital
Sees GP
(usual care
path)
Flow Chart of Process:
Public Patient

12. Cause and effect diagram

13. Cause and effect diagram
Lack of Clinics!

14. Cause and effect diagram
Lack of Clinics!

15. Intervention
 GP Access and Education:
 GP education evening Sept. 2014
 Medicare local supported FOBT clinic in their
online newsletter
 Expedited referral to RNSH using template on
medicare local website
 Clinic Triage:
 Registrar and CNS

16. • GI Clinic Capacity:
– Extended by 1 hour (=25% increased capacity)
– Introduction of fortnightly FOBT Clinic
 Staff specialist/bulk billed
• Endoscopy Unit Capacity:
– All endoscopy lists have slot for 1 FOBT patient

17. Initial Analysis and Results
• Review of colonoscopies performed at RNSH
for the indication of +FOBT
• Before Intervention: 1/7/13 – 15/1/14
• After Intervention: 1/7/14 – 15/1/15

18. Colonoscopy results

19. Time from Referral to Colonoscopy
50%
25%
75%

20. Time from Referral to Clinic

21. Time from Clinic to Colonoscopy

22. Since January 2015
• 106 referrals for FOBT
– 94 have had colonoscopy thus far:
• 5 cancers
• 37 patients with polyps

23. FOBT Clinic
• 60 patients seen in FOBT Clinic
– 41 colonoscoped
– Timeframes (median; 25% and 75%):
• Referral to Consultation: 31 days (20 and 72)
• Consultation to colonoscopy: 24 days (21 and 44)
• Referral to colonoscopy: 62 days (47 and 109)

24. Strategies for Sustaining
Improvement
• 1year funding from Cancer Institute to support
CNS.
-Beyond that fund via FOBT Clinic
• Quarterly assessment of volume and times to
colonoscopy of FOBT patients (KPI for our unit)
• Strategies in place to deal with increased
colonoscopy load
– Triage
– I extra list/week (extra 250/yr)
– Back-fill empty lists

25. Strategies for Sustaining
Improvement
• 1year funding from Cancer Institute to support
CNS.
-Beyond that fund via bulk-billed FOBT Clinic
-Plus increased activity from nurse-run clinic
• Quarterly assessment of volume and times to
colonoscopy of FOBT patients (KPI for our unit)
• Strategies in place to deal with increased
colonoscopy load (endoscopy unit)
– Triage
– I extra list/week (extra 250/yr)
– Back-fill empty lists

26. The End (of the beginning)
26