Support services

Only rarely will a person undergoing a primary screening procedure require admission to hospital for further care. Thus it is not necessary to have medical support facilities close at hand. However, services performing endoscopy in more remote settings must have robust guidelines and processes in place to enable patients to be resuscitated effectively and be transferred rapidly and safely to a hospital where surgical services are available. On this basis it is recommended that any screening service, regardless of setting, should make an assessment of risks and develop the ability to respond to emergencies

While there are no absolutes, a case can be made for delivering high-volume screening endoscopy outside traditional hospital settings to improve the patient experience and to reduce healthcare and societal costs. In contrast, risk assessments will indicate that colonoscopy following a positive FOBT or a positive FS is a more complex procedure that is associated with higher risks and should, therefore, be performed in acute hospital settings. 

Audit and quality improvement  

This section proposes that endoscopy services monitor key outcomes to ensure that a high-quality and safe service is being provided and to identify areas in need of improvement. Two terms are used for such outcomes: auditable outcomes and quality indicators. An auditable outcome refers to an outcome that should be measured, but for which there is not an evidence base to recommend a standard, such as the comfort of the procedure. A quality indicator is an outcome for which there is a sufficient evidence base to recommend a standard, such as caecal intubation rate.

It is expected that some auditable outcomes will become quality indicators as the evidence base improves, and that the standards of quality indicators will rise as standards improve. 

On the basis of this, it is recommended that all screening programmes should have processes in place for monitoring, auditing, reviewing and acting upon key auditable outcomes and quality indicators in the following areas 

• Quality; 
•  Safety; and 
•  Patient feedback