Introduction
Colorectal cancer screening, particularly through colonoscopy, is a pivotal element of preventive healthcare. Understanding the multifaceted factors influencing Adenoma Detection Rates (ADR) is crucial for optimizing the effectiveness of screening programs. This study aims to provide a detailed analysis of the impact of electronic patient records, clinical interventions, and other variables on ADR trends in a gastroenterology unit.
Aims & Methods
Aim: This study aims to investigate the factors contributing to the increase in ADR over time through the implementation of a comprehensive colonoscopy Quality Indicator recording system.
Methods: This study investigates the trends in Adenoma Detection Rates (ADR) and associated factors in a gastroenterology unit over a four-year period. The primary outcome is the evolution of ADR, with secondary outcomes including the relationship between ADR and withdrawal time, endoscopists' experience, and the Boston Bowel Preparation Scale (BBPS). The introduction of electronic patient records in 2019 establishes the baseline for data analysis.
In 2022, a full-time clinical nurse specialist in endoscopy began actively monitoring key indicators, such as ADR, BBPS, and withdrawal time. These metrics were regularly communicated to endoscopists through a PowerBi dashboard. As part of clinical interventions, a patient preparation video was introduced to enhance communication and standardize information for patients undergoing colonoscopies.
Results
We included patients aged 50 or older, with a total of 3340 colonoscopies performed between January 2019 and September 2023. 8000 colonoscopies are performed per year, but we only include the adenoma screening indications.
The analysis revealed a significant increase in ADR in 2020, coinciding with the introduction of electronic patient records. This marked rise, at 13.5%, suggests a positive influence of improved record-keeping on diagnostic accuracy. However, subsequent years showed a more modest increase of 0.4%, indicating a potential plateau effect. In 2022, the introduction of a full-time clinical nurse specialist in endoscopy corresponded with changes in key indicators.
The BBPS showed a significant decrease in 2023 compared to 2022 (p=0.03), while a reverse trend was observed between 2020 and 2021 (p = 0.03 ). Endoscopist's experience (p= 0,2470), and BBPS scores (p= 0,1652) were no significant predictors of the increased ADR. Adjusted for the other variables included in the model. These findings underscore the complex interplay of various factors influencing outcomes.
Conclusion
The dynamic nature of ADR observed in this study prompts a closer examination of the long-term effects of electronic patient records on diagnostic accuracy. The initial surge in ADR following their introduction suggests a positive and immediate impact on procedural outcomes. However, the subsequent stabilization of ADR raises questions about the sustainability of this effect over time. The introduction of a full-time clinical nurse specialist in endoscopy in 2022 may have contributed to the observed changes in BBPS. This emphasizes the potential benefits of multidisciplinary collaboration in optimizing colonoscopy outcomes. The observed decrease in BBPS in 2023, coupled with the sustained ADR levels, suggests a need for ongoing assessment of clinical interventions. The patient preparation video, introduced as part of enhanced communication strategies, may have contributed to these changes. Future research should delve deeper into the nuanced impact of such interventions on procedural outcomes and patient experiences.