|Title:||Clinical guidelines for the management of the public colonoscopy wait list|
|Document ID:||Operational Circular OP 1955/05|
|Date of issue:||Thursday, 26 May 2005|
|Status:||NO LONGER APPLICABLE|
|Description:||This Operational Circular details the clinical guidelines to be followed when placing patients on the public waitlist for colonoscopy.|
|Applicable to:||Clinical and administrative staff of the Department of Health|
|Period of effect:||from 27 May 2005|
|Authorised by:||Dr Andrew Robertson, Acting Group Director, Statewide Policy Division, 23-May-2005|
|Print version:||View print version|
Clinical guidelines for the management of the public colonoscopy wait list
This Circular details the clinical guidelines to be followed when placing patients on the public waitlist for colonoscopy.
Clinicians performing colonoscopy in the public health sector must be properly credentialed by the health service in which they operate. Credentials include formal qualifications, evidence of training, of experience and of the clinical competence of the health care professional.
The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy is a national body comprising representatives from the Gastroenterological Society of Australia (GESA), the Royal Australasian College of Physicians (RACP) and the Royal Australasian College of Surgeons (RACS). The Committee recognises endoscopic training of specialist physicians and surgeons, who have completed their training in Australia or who are now practicing in Australia. An updated register of all endoscopists whose training has been recognised is maintained at the secretariat. Evidence of registration with the conjoint committee should be considered by health service credentialing committees. No endoscopist should undertake Paediatric colonoscopy unless specifically trained to do so.
The pre-operative assessment of the colonoscopy patient should be performed by the endoscopist, who is to perform the procedure, or by a suitably credentialed colleague. Assessment will include the need for colonoscopy, the patient's suitability for day surgery and the urgency of the situation. All patients undergoing colonoscopic procedures require pre-procedural evaluation to assess their risk and to help manage problems related to pre-existing medical conditions. A history and focused physical examination, review of current medications and drug allergies, as well as an assessment of cardiopulmonary status at the time of the procedure are necessary to adequately provide for the safety of the patient.
In many instances, the General Practitioner or referring specialist will have undertaken an assessment of the patient's suitability for direct access colonoscopy. A written referral of this type will suffice as long as a credentialed colonoscopist or a suitably credentialed colleague considers that the prime issues are addressed and that major changes in the patient's condition are not likely to occur prior to the date of colonoscopy. Acknowledging that direct access colonoscopy is commonly practiced, it is important to recognise that bowel preparation is considered part of the procedure. Accordingly, the information provided to direct access patients prior to bowel preparation should include a mechanism by which they have the opportunity to ask questions or arrange formal clinical review, should they wish.
Addition to Public Waitlist for Colonoscopy
Clinicians should be mindful of published indications and guidelines for colonoscopy and colorectal cancer when considering which patients should be listed for the procedure. Useful resources include those developed by the European Panel on the Appropriateness of Gastrointestinal Endoscopy and the NHMRC 'Guidelines for the prevention, early detection and management of colorectal cancer'. Particular care should be taken to minimise unnecessarily frequent or unnecessary follow-up.
Addition to waitlist
Following identification of a problem requiring colonoscopic assessment and assessment of the patient's suitability and consent for colonoscopy, the patient may be added to the public waitlist for colonoscopy. The addition of a patient to the waitlist should be on the basis of clinical guidelines and only when the patient is at ready-for-care status. Clinical audits of the colonoscopy waitlist will be undertaken on a regular basis and any patients not ready for colonoscopy will be removed from the waitlist.
Assessment of urgency
Patients should be assigned to an urgency category with reference to standard descriptions.
Facilities and staffing
Health services performing colonoscopy should ensure that their facilities and staffing promote patient safety and service quality and comply as far as possible with the GESA 'Standards for Endoscopic Facilities and Services' although local circumstances must be taken into account. Cleaning and disinfection facilities and training of relevant staff should conform to the GESA 'Infection control in Endoscopy' guidelines.
Sedation for colonoscopy
The College of Anaesthetists (ANZCA), GESA and the Royal Australian College of Surgeons have recommended that during a colonoscopy procedure, a person must be present who is trained in acute resuscitative measures and whose principal responsibility will be to monitor the patient's level of consciousness and cardiorespiratory status and assist resuscitation if required. If major risk factors are identified or difficulties can be anticipated, involvement of an anaesthetist is recommended.
Dr Andrew Robertson
This circular last updated: Monday, 30 May 2005 at 3:13pm