|Title:||Assessment and access criteria for public colonoscopy services|
|Document ID:||Operational Directive OD 0409/12|
|Date of issue:||Friday, 14 December 2012|
|Status:||NO LONGER APPLICABLE|
|Description:||A standardised approach to risk assessment and access criteria for public colonoscopy services to effectively manage demand, and ensure those most at risk are seen within clinically appropriate timeframes, at the most appropriate hospital /clinic.|
|Framework:||Clinical Services Planning and Programs Policy Framework|
|Period of effect:||from 19 November 2012 to 19 November 2017|
|Review date:||19 May 2017|
|Authorised by:||Kim Snowball, Director General, Department of Health, 29-Nov-2012|
|Print version:||View print version|
Assessment and access criteria for public colonoscopy services
This Operational Directive updates the information in the previous Operational Circular OP 1955/05 and details the processes and guidelines to be followed when placing patients on the public waitlist for colonoscopy.
WA Health has developed standardised direct access (DA) exclusion criteria to assist in streaming patients towards appropriate care pathways and avoiding unnecessary delay. Appropriate low to moderate risk cases are to be referred through DA and/or the Ambulatory Surgery Initiative (ASI). The standardised exclusion criteria for DA and ASI are shown in Attachment A. Acknowledging that DA colonoscopy is widely practiced, it is important to recognise that bowel preparation is considered part of the procedure. Accordingly, the information provided to DA patients prior to bowel preparation should include a mechanism to ask questions, should they wish.
Pre-operative assessment of high risk patients needs to be performed by the endoscopist who is to perform the procedure, or by a suitably credentialed colleague. Assessment will include the patient’s suitability for day surgery and the urgency of the situation. All high risk patients undergoing colonoscopy require a pre-procedural evaluation to assess their risk and to help manage problems related to pre-existing medical conditions. In many instances, the general practitioner (GP) or referring specialist will have undertaken an assessment of the patient’s suitability for colonoscopy and noted risk factors including those in Attachment A. The credentialed colonoscopist or a suitably credentialed colleague will ensure 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.
The assessment of the patient for colonoscopy should be lead by the GP with the patient with particular regard to:
Addition to the public waiting list for colonoscopy will require the GP to:
Health Service co-ordination
The Health Services are required to establish Health Service wide arrangements to facilitate the management and co-ordination of colonoscopy services as described in the Model of Care for Colonoscopy Services (2009), which will facilitate patient movement cognisant of case complexity, care pathways for DA/ASI, specialist availability and infrastructure requirements. The Health Service will:
The addition of a patient to the public waitlist will only occur when the patient referral:
Clinical audits of the waitlist will be undertaken on a regular basis and any patients not ready for colonoscopy will be removed from the waitlist. Particular care should be taken to eliminate unnecessary follow-up.
Patients should be assigned to an urgency category with reference to standard descriptions.
WA Health endorses equity of access for consumers and the principle of ‘first on first off’, for all wait listed cases by category.
The role of innovation and technology in public colonoscopy services
WA Health, through the Cancer and Palliative Care Network will facilitate an expert group to consider the resourcing and costing of colonoscopy and CT colonography (CTC). The expert group will develop guidelines on the indication and utility for CTC.
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 (or international equivalent) must be produced prior to approval by the health service credentialing committees. Proceduralists may only undertake procedures for which they have received CCRTGE accreditation.
Sedation for colonoscopy
The Australia and New Zealand College of Anaesthetists (ANZCA), GESA and the RACS 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.
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’ (2011). Cleaning and disinfection facilities and training of relevant staff should conform to the GESA ‘Infection control in Endoscopy’ guidelines.
This circular last updated: Friday, 14 December 2012 at 3:48pm