‘We have a huge demand for endoscopy services and not much capacity to deliver that, along with a shortage of space to create new capacity.’
Ann Vandeleur, Project Nurse Manager, The Prince Charles Hospital, Brisbane
Australia urgently needs more colonoscopy capacity to address:
- The impact of surveillance requirements due to the National Bowel Cancer Screening Program which became fully operational for 50-74-year-olds in January 2020
- A backlog of surveillance and symptomatic cases due to COVID-19
- The increasing incidence of bowel cancer in younger people – 10% of cases and 5% of deaths now occur in people under 50
- Calls to extend the national bowel cancer screening program to cover approximately 2 million people aged 45-49.
Here we will outline the clinical need to provide more colonoscopies and then describe an innovative and bespoke solution to increase your hospital’s capacity quickly, easily and effectively without adding to your own workload.
The clinical case for increasing colonoscopy capacity
There is an impending bowel cancer crisis in Australia. Screening rates and surveillance colonoscopies dropped during COVID-19 with colonoscopy rates falling by 55% in March and April 2020.
COVID-related disruption has had a lasting effect on the healthcare system. Regional hospitals in Victoria report a year-long backlog in elective procedures, while colonoscopy waiting times in Tasmania are more than triple the benchmark.
Yet some of those capacity constraints pre-date COVID. When detected early, the five-year survival rate for bowel cancer can be as high as 99%. However, even prior to the pandemic, only 46% of bowel cancer cases were diagnosed in Australia at an early stage.
Patients at a recent Q-bital Healthcare Solutions reported lengthy pre-2020 delays in accessing colonoscopy through the public system with some uninsured patients opting to pay thousands for a private scope rather than wait 8+ months to find out whether they had cancer.
Then there is the alarming rise in bowel cancer incidence in younger people. Of the top 10 cancers in Australia, bowel cancer was the only one to show an increase in mortality rates from 2008-2018 in the 45-49 cohort from 2008-2018. That is why there are calls to extend screening to this age group.
Bowel cancer is now the deadliest cancer among young Australians aged 25-44. Patients who present with symptoms of fatigue, anaemia, weight loss or bloody stools are often misdiagnosed initially but most are, eventually, referred for a colonoscopy. They cannot afford to wait even longer for a colonoscopy. Yet many have to, meaning that their cancers are diagnosed late, narrowing treatment options and worsening outcomes.
Undeniably, Australia needs more colonoscopy capacity to manage an impending bowel cancer crisis. Where can it come from though?
Increasing your colonoscopy capacity
Hospitals are large, complex bureaucracies and change tends to be achieved slowly – while waiting lists grow quickly.
Increasing colonoscopy capacity involves avoiding time lost due to inadequate preparation by patients and creating extra facilities.
Ensure patients prepare properly
Many people are aware that it’s necessary to fast before a surgical procedure but few understand what’s involved in preparing for a colonoscopy until they actually do it.
Proper bowel preparation takes days and involves:
- Stopping or changing the dose of some medications and supplements used for common conditions like low iron levels, diabetes, heart disease and high blood pressure
- Eating a low-fibre ‘white’ diet (white bread, rice bubbles, plain yogurt etc) for 48 hours before the procedure
- Eating nothing after breakfast on the day before the procedure
- Taking laxatives to empty the bowel
- Following nil by mouth from 5.30 am on the day of the procedure.
That’s quite an intensive process with special instructions needed for patients with comorbidities. It can also be quite unpleasant. It’s not particularly surprising that a substantial number of patients fail to prepare properly.
A 10-year retrospective study published in 2019 found that nearly 1 in 4 patients had inadequate bowel preparation which compromised the effectiveness of the colonoscopy. That represents a substantial waste of operating room time – something no hospital can afford.
It takes longer to perform a colonoscopy on a patient who has not prepared their bowel properly. Colonoscopies performed on such patients are also less effective at detecting polyps and cancers. Because of this, such patients have to go back on the waiting list because another colonoscopy is necessary – hopefully with proper preparation this time.
Inadequate bowel preparation is more likely in patients who are:
- Older
- Male
- From a minority group.
Providing additional support to such patients may result in a worthwhile colonoscopy. It also prevents patients from returning to the waiting list.
Investigate mobile and modular endoscopy suites
Building a new ‘bricks and mortar’ endoscopy suite usually requires too much time and money to be a realistic solution to the immediate pressures of a long waiting list.
In contrast, mobile and modular facilities can be constructed in a matter of months on a fraction of the budget. They meet all relevant compliance standards and deliver a high-quality experience for both patients and clinicians.
Case study: The Prince Charles Hospital, Brisbane
The Prince Charles Hospital in Brisbane recently installed a mixed-modality endoscopy suite consisting of both mobile and modular infrastructure. Comprising of a mobile operating room, a mobile ward and a modular decontamination facility, the solution will provide an additional 24-27 colonoscopy procedures each day, or 6,600 each year.
The introduction of this facility supports the hospital to maintain targets by improving patient flow and addressing backlogs. The mobile and modular operating room facilities offer a significant increase in capacity for the duration of high patient demand periods. The operating room solution has provided Prince Charles Hospital with a reliable, safe answer to capacity pressures.
‘People couldn’t believe what was being created, and so quickly. If you built from scratch it could take three or four years. Not only has it been delivered in a fraction of that time, it’s been delivered to the quality and standard we and our patients need and expect, safely.’
Ann Vandeleur, Project Nurse Manager,
The Prince Charles Hospital, Brisbane
Solving your colonoscopy capacity challenges
If you would like to explore a similar solution to ease your hospital’s colonoscopy capacity pressures, please contact Q-bital.
