Booking processes must be robust to minimise late cancellations and failures to attend. To increase
the chance of attendance an invitation for a primary screening test should be sent 2–3 weeks before
the procedure is due, with an option for the patient to change the appointment if it is not convenient
Auditable outcome: Patient feedback on booking processes.
Timelines
A timely procedure is not critical in the context of primary screening but it is very important when endoscopy
is performed following a previous positive screening test. A delayed procedure may not be
critical biologically, but it can cause unnecessary anxiety for the screenee.
To ensure that patient anxiety is not unnecessarily increased, it is recommended that follow-up
colonoscopy after positive screening be performed as soon as reasonably possible, but no later than
within 31 days of referral (acceptable >90%, desirable >95%)
Auditable outcome: Time taken from positive screening test to secondary endoscopic examination.
If further pathological information is required before the decision to perform a colonoscopy, then the
maximum and the desirable targets of four and two weeks, respectively, should be timed from the
receipt of the pathology report. The pathology report should be delivered to the screening programme
within two weeks.
Environment
The environment should be conducive to a good experience and efficient processing. It should be
physically comfortable, offer privacy and there should be facility to hold private conversations with
screenees and their relatives. The reception and assessment areas should be separate from recovery
facilities
Auditable outcomes: patient feedback on environment and patient turn around times.
During the procedure
There is an increasing body of evidence demonstrating unacceptable miss rates of cancer following
colonoscopy. Miss rates vary between endoscopists suggesting that care with the examination and
technique play a key role in ensuring cancer is not missed.
Endoscopists must have a mix of technical, knowledge and judgement competencies to identify and
successfully remove high-risk lesions. Ideally they will perform a complete examination quickly, safely
and with minimal discomfort, leaving time to properly inspect the colon, and safely remove and retrieve
lesions. They will identify all abnormal areas, characterise them and make a judgement of what
to do. They will then, if it is appropriate to do so, safely remove and retrieve all neoplastic lesions
Providing such high-quality and safe endoscopy requires a team approach with appropriate equipment
immediately to hand. The nursing support team must ensure the patient is comfortable and has stable
observations to allow the endoscopist to devote his attention to the procedure. The nurses also provide
important technical support ensuring endoscopy equipment is serviceable and that all the necessary
accessories are readily available. Finally they play an important role supporting the endoscopist
during therapeutic procedures. Both endoscopist and nurse should regularly reflect on their practice
together with pathology and surgical teams in order to optimise patient outcomes.
