OC-062 A Multi-centre Pragmatic Study Of An Educational Intervention To Improve Adenoma Detection At Colonoscopy

Abstract

INTRODUCTION: High quality colonoscopy prevents colorectal cancers. Low adenoma detection rates (ADR) are linked to subsequent high interval cancer rates. Variability in ADR exists between practitioners. Withdrawal time of >6 minutes; Buscopan use; position changes; and rectal retroflexion have some evidence to improve lesion detection. Implementation of evidence based 'bundles' of care has shown to be effective in improving outcomes in other healthcare settings1. AIMS&METHODS: We aimed to evaluate both the feasibility of implementing a 'bundle' comprising the above measures into routine practice and the effect on ADR. Twelve English endoscopy units participated. All nominated a lead endoscopist and nurse. A model combining central training, locally led implementation, feedback and ongoing study team support was used. Colonoscopists' ADRs were measured for 3 months prior to and for a 9 month period following implementation. Colonoscopists performing >= 25 procedures during the period before were ranked according to ADR and quartiles were constructed. Change in Buscopan use was used as a surrogate marker for intervention uptake. A corrected Chi Squared test was used to check for significant change. RESULT(S): One hundred and eighteen colonoscopists were included in the global analyses and 68 in analyses of quartiles. The study included 17411 colonoscopies, 4351 and 13060 in the pre and post intervention periods respectively. There was a significant global increase in Buscopan use (15.8% vs. 54.8%, p<0.001), also seen in each quartile, and ADR (16.0% vs. 17.7%, p=0.009), Table 1. (Table presented) CONCLUSION(S): Our evidence based educational intervention resulted in a significant change in behaviour, evidenced by increased Buscopan use. A significant increase in the global ADR occurred, and ADR also improved significantly in the two lower quartiles. A fall was seen in the upper quartile, but the ADR in this group remained above that in the other groups and the global mean of 17.7%. This study demonstrates that simple evidence based educational interventions with support can significantly change practice and ADR, particularly amongst the poorest performers.