Advisory AS18/12: Implementing the Colonoscopy Clinical Care Standard

Advisory details

Purpose

To describe assessment requirements for Actions 1.23, 1.24, 1.27b, and 1.28a of the National Safety and Quality Health Service (NSQHS) Standards (second edition) for health service organisations implementing the Colonoscopy Clinical Care Standard.

Issue

The Australian Government Department of Health asked the Commission to develop a safety and quality model for colonoscopy. The appointment was made in the context of the expanded screening of the Australian Government National Bowel Cancer Screening Program.

The Safety and Quality Model for Colonoscopy Services in Australia incorporated three key elements:

• A Colonoscopy Clinical Care Standard for the delivery of high quality services
• Certification and periodic re-certification of colonoscopist’s performance
• Collation and review of indicators and performance targets in accordance with a standard national data set.

The Colonoscopy Clinical Care Standard has received endorsement by the clinical colleges and societies whose members perform colonoscopy. The Clinical Colonoscopy Standard was noted by the Australian Health Ministers’ Advisory Council in June 2018.

The Colonoscopy Clinical Care Standard relates to the care of adult patients undergoing colonoscopy for screening, diagnosis, surveillance, and/or treatment. It covers the period from when a patient is referred for consideration of colonoscopy through to the planning of follow-up after the procedure. The Colonoscopy Clinical Care Standard is relevant to the care provided in primary and acute healthcare settings including general practice, day procedure services, private hospitals and public healthcare services. All patients undergoing a colonoscopy should be offered the care set out in each of the nine quality statements of the Colonoscopy Clinical Care Standard.

Health service organisations providing colonoscopy services are required to implement the Colonoscopy Clinical Care Standard taking into consideration the services provided and the patient risks associated with those services. As care spans primary and acute healthcare services, implementing the Quality Statements may be the responsibility of more than one provider. 

Implementing the Colonoscopy Clinical Care Standard aligns with the following requirements in the NSQHS Standards (2nd ed.):

The guidance on roles and responsibilities of clinicians involved in colonoscopy, set out in Attachment 1, are consistent with codes of conduct of health professionals including Good Medical Practice: A Code of Conduct for Doctors in Australia.  Senior clinicians have primary responsibility for the oversight and coordination of the processes of patient care and the outcome of care including the patient’s experience, even when some care tasks are delegated to other clinicians. 

Colonoscopists have primary responsibility for shared decision making about the appropriateness of a colonoscopy, including:

• informing patients of risks and benefits of procedures
• assigning clinical priority
• assessing and preparing patients for a colonoscopy
• performing the procedure and any required follow-up. 

This Advisory applies to all health service organisations providing colonoscopy services.

Requirements

Health service organisations implementing the Colonoscopy Clinical Care Standard are required to: 

1. define the scope of clinical practice and credential clinicians providing colonoscopy services
2. provide relevant clinicians including proceduralists (medical and surgical, generalist, endoscopy unit staff, nursing endoscopists), anaesthetist providing sedation, with access to the Colonoscopy Clinical Care Standard
3. review the Quality Statements against the services provided and the risks of providing services
4. document in a policy or procedure 
5. the Quality Statements (or part of a quality statement) that are its responsibility and determine which indicators are to be monitored, in line with the guidance provided at Attachment 1
6. the clinical indicator data, which data will be provided to procedural specialists as feedback and where else the data may be reported
7. the requirement for procedural specialists to provide evidence of certification and recertification as part of the credentialing process
8. provide procedural specialist clinicians with a copy of the policy or procedure relating to its implementation of the Quality Statements and the indicators being monitored
9. implement the Quality Statements and monitor indicators that are its responsibility 
10. use the Colonoscopy Clinical Care Standard indicators and other performance data to monitor variations in practice against expected health outcomes and to provide feedback to clinicians on their practice.

Assessors are required to review evidence that the health service organisation has: 

• implemented the Colonoscopy Clinical Care Standard, where relevant 
• defined the scope of clinical practice for all clinicians providing colonoscopy services and credentialed relevant clinicians
• provided clinicians with access to the Colonoscopy Clinical Care Standard 
• provided procedural specialist clinicians with written advice of the Quality Statement for which the organisation is responsible from the Colonoscopy Clinical Care Standard 
• applied the requirements set out in the Quality Statements and monitored indicators for the Colonoscopy Clinical Care Standard
• continually monitored variation in practice and provided clinicians with feedback. 

Where the health service organisation has met these requirements, this supports compliance with elements of Actions 1.23, 1.24, 1.27b, 1.28a,b. 

Providers and responsibilities for Quality Statement

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