Patient considerations

Patients generally prefer services that are close to home and easily accessible. Thus high-volume screening endoscopy is probably best situated closer to the population to be screened. In contrast, level 3 and 4 expertise for removing high-risk lesions is likely to be provided at district and regional levels respectively. The priority here is the facility and expertise, not proximity. 

When implementing high-volume screening endoscopy consideration should be given to locating services in convenient locations for patients to maximise engagement in screening

Possible destabilising effect on symptomatic services

Unplanned introduction of screening endoscopy (at whatever level) creates additional demand and may lead to destabilisation of the symptomatic service. Thus, if endoscopy for screening is introduced alongside symptomatic services, care must be taken to ensue there is sufficient new capacity. 

An assessment of the impact of demand from screening on waiting times for symptomatic patients should be made to ensure that there is sufficient planned new capacity such that screening does not lengthen waits for symptomatic patients

Infrastructure and efficiency 

The infrastructure requirements for high-volume screening endoscopy need to cater to large numbers of presumptively healthy people. High-volume screening endoscopy requires efficient booking, assessment and recovery processes to function effectively without compromising the patient experience. Thus, it may be advantageous for high-volume screening activities to be separated from routine clinical endoscopy and follow-up endoscopy of screen-positives. 

It is self-evident that the infrastructure must be adequate. It must include facilities for pre-procedure assessment and recovery, and must also be designed to allow good patient flow in order to maximise efficiency (VI - B).Rec 5.9 In addition, a suitable environment will maintain the privacy and dignity of patients (VI - B).Rec 5.10

Endoscopist and support staff competencies

Endoscopists and supporting staff providing endoscopy screening must be competent to deliver high quality FS or colonoscopy in order to achieve high patient satisfaction and all the required performance standards relating to quality and safety

It is a fundamental requirement of quality assurance that all endoscopists and centres performing endoscopy should participate in a continuous quality improvement programme, including individual tracking of quality and safety indicators. This should include management plans, for both endoscopists and staff, for addressing suboptimal quality