Surveillance colonoscopies for colorectal polyps--too often, too many! An Audit at a Large District General Hospital.

INTRODUCTION: The British society of Gastroenterologists (BSG) have laid down guidelines for surveillance colonoscopies in patients with large bowel adenomatous polyps. However, numerous studies have shown the gross over-utilization of colonoscopic services in their management. We audited our practice of polyp management and looked at guideline compliance amongst patients on our colonoscopic surveillance list.
METHOD: All patients undergoing adenoma surveillance and those with newly detected adenomas over a 2-month period were included in the first loop of the audit. Data on the colonoscopic findings, histology and management were retrieved from paper and on-line records. The BSG guidelines were printed, laminated and displayed in the colorectal clinics. Following this, we re-audited (second loop) our practice. In the second part of the study, we randomly retrieved 533/1800 case notes from our colonoscopic waiting list. Amongst those on surveillance for polyps, compliance was ascertained as regards need for procedure and appropriateness of surveillance interval.
FINDINGS: Fifty-four patients were included in the first loop and 59 during the second loop of the audit. Guidelines were followed in 16% (4/25, 95% CI: 0.054-0.33) of patients in the first loop and 46.5% (13/28, 95% CI: 0.293-0.642) in the second loop (P = 0.017). Of the patients on our colonoscopic waiting list for adenomatous polyps, 17.7% satisfied guidelines, 23.4% did not require any further surveillance and 58.9% were booked for a procedure earlier than recommended.
CONCLUSION: The mere framing of guidelines is insufficient to improve clinical practice. Strategies to improve implementation need to be explored. Audit of individual practice is recommended.