Volume 187 - Issue 4
Colonoscopy capacity in selected New South Wales hospitals
Authors: Shelanah A Fernando, Anne E Duggan, Owen F Dent and Maeve C Eikli
Med J Aust 2007; 187 (4): 249-250. || doi: 10.5694/j.1326-5377.2007.tb01218.x
Published online: 20 August 2007
Published online: 20 August 2007
To the Editor: The recent editorial by Macrae1 outlined the potential issues facing the rollout of the National Bowel Cancer Screening Program. It is estimated there will be about 5000 additional colonoscopies performed in New South Wales in the first year.2 To ascertain how the NSW public health system might absorb this increased demand, the Greater Metropolitan Clinical Taskforce (GMCT) Gastroenterology Network conducted a survey in 2006, featuring structured interviews with clinicians. Our aims were to estimate the current capacity of NSW public hospitals to perform colonoscopies and to identify perceived impediments to meeting future demand.
From a total of 113 public hospitals where colonoscopies had been performed in the period 2001–2004,3 we selected a purposive sample of 32 where there had been at least 500 procedures, or which were regarded as major providers in their area health service. Responses were received from 26 hospitals, which represented 54% of colonoscopies performed in all public hospitals in NSW in 2001–20043 and included both metropolitan and rural hospitals. No information was collected from the private sector. Fifteen hospitals had dedicated endoscopy suites, 10 used operating theatres, and one unit used a day surgery centre.
We found that for the majority of these hospitals (23/26), colonoscopy activity is currently at or near maximal capacity, with limited potential for expansion of services. The additional number of colonoscopies that could be accommodated ranged from one to four per week in six hospitals, up to a maximum of eight per week in a single hospital. Reasons for unbooked hours included insufficient funds, and a lack of nurses and anaesthetists.
The Box summarises other key findings, which emphasise that the three major factors limiting activity are insufficient endoscopy nurses, insufficient nursing applicants, and the need for more equipment. Importantly, an absolute shortage of proceduralists was not found to be a restricting factor. Rather, insufficient available colonoscopy time for existing proceduralists was identified as a limitation.
While our survey was successful in clarifying factors that impede optimal performance, the small number of participating hospitals is a relative limitation. Nevertheless, the survey suggests a requirement for additional nursing staff and equipment, and for the establishment of uniform data collection and reporting systems. Areas requiring further exploration include greater unit efficiency, opportunities for workplace redesign, and consideration of inequities in access to anaesthetic cover for patients in public hospitals. The GMCT Gastroenterology Network is currently working on these issues in collaboration with the NSW Department of Health.
Factors affecting colonoscopy capacity in selected New South Wales public hospitals*
Most responding units (22/26) regarded additional nursing staff as a medium to high priority requirement
Increasing time available to existing proceduralists (18/25) and allocating time for new proceduralists (16/25) were regarded as medium to high priorities
11/15 hospitals with dedicated endoscopy suites had an unused endoscopy room. Most common reasons were: insufficient funds (5); lack of nurses (5); insufficient equipment, including anaesthetic machines (3); and lack of anaesthetists (2)
No unit cited a shortage of proceduralists as a reason for the unit not running at full capacity
“For” (11/24) and “against” (13/24) responses for the addition of procedure rooms were evenly spread across responding facilities
Prioritisation of colonoscopies over other procedures was not favoured (14/24 ranked this of low importance, 5 as neither low nor high, 5 as medium to high)
Most important factors impeding capacity were:
Lack of approval to recruit nursing staff (18/23)
Shortage of nursing staff applicants (16/25)
Budgetary limitations (19/25)
Insufficient endoscopy time for existing proceduralists (17/25)
Insufficient budget to recruit new proceduralists (16/23)
Only 2/26 units (both using operating theatres) had a data manager recording data and compiling statistics; others (13/26) in dedicated endoscopy suites used commercial reporting systems, such as Endoscribe, however the survey did not determine how systematically and completely data were compiled and reported from these systems
Acknowledgements
All clinicians who contributed to the survey gave up their time on a voluntary basis. We thank everyone who contributed, particularly Cameron Bell and John Napoli, who assisted with the pilot studies.
References
- Macrae FA. Providing colonoscopy services for the National Bowel Cancer Screening Program [editorial]. Med J Aust 2007; 186: 280-281.
- Australian Government Department of Health and Ageing. The Australian bowel cancer screening pilot program and beyond: final evaluation report. Screening Monograph No. 6/2005. Canberra: Commonwealth of Australia, 2005. 0_i1091839
- Health Information Exchange. Colonoscopy activity across NSW Area Health Services by financial year 2001–2004, selected DRGs, admitted patients only. Sydney: NSW Health, 2005. 0_i1091841