A prospective intervention study of colonoscopy reporting among patients screened or surveilled for colorectal neoplasia

BACKGROUND: The impact of modifying electronic colonoscopy reporting software for improving adherence to guidelines regarding quality standards documentation remains poorly characterized. METHODS: Consecutive colonoscopy reports of patients undergoing screening or surveillance for colorectal neoplasia were reviewed. Following a pre-intervention quality audit conducted in 2009, some modifications were made to the reporting software (Endoworks, Olympus Corporation, USA), including changes to field navigation, drop-down menus and visual cues, to optimize all compulsory items identified by existing guidelines in the report-generating template. Results from both audits were compared. Independent validation of 10% of all data was completed. RESULTS: In 250 patient reports (mean [+/- SD] age 61.7 +/- 10.2 years, 51.2% female, February to May 2011) of five endoscopists (mean 11.6 +/- 7.8 years in practice), procedural indication was always present, as was informed consent. Seventy-six per cent of patients had undergone previous colonoscopy, 41% provided a previous colonoscopy date, with details on past polyp removal in 42.9%. Most procedural indicators were recorded (examination date 100%, medications given 100%, difficulty level 96.4%, preparation quality 100%). All reports noted extent of visualization (cecal intubation in 97.6%, photo documentation in 96.8%). Total procedural time was recorded in 8.2% and withdrawal time in 44%. Polyps were reported in 112 patients (44.8%), with polyp size (5.01 +/- 4.42 mm) reported in 95.5%, morphology in 88.4% and anatomical location in all. The method of polyp removal was missing in 2.7% of reports. Significant improvements were noted in the documentation of withdrawal and total time, cecal landmarks, type of bowel preparation, completeness of removal, morphology and method of polyp removal, and photo documentation compared with the 2009 audit. CONCLUSION: These results illustrate the value of targeted modifications to an electronic colonoscopic reporting system in significantly enhancing the quality of reporting.