Electronic Web-Based Colonoscopy Guidelines: Ease of use and improved compliance

Abstract

Background and Objectives: There is an increasing demand for colonoscopy which tends to exceed service provision. To ensure appropriate referral for colonoscopy, the National Health and Medical Research Council (NHMRC) have developed comprehensive, evidence-based guidelines addressing screening and colonoscopy surveillance. However, some reports suggest that compliance with the guidelines is variable. This study was conducted to determine the compliance rates in our institution and to drive improved adherence to the national guidelines. Patients and Methods: This is a retrospective, observational study of all colonoscopies performed from July 2007 to June 2011. A decision support tool was specifically designed and made available via the World Wide Web. To assess the impact of the decision support tool, we measured compliance rates prospectively in January 2011 and January 2013. Results: Over the two periods of pre- and post-intervention, there were 103 and 98 patients referred to waiting lists for colonoscopy. Following introduction of the web-based decision support tool, the national colonoscopy guidelines compliance rate increased from 70.5% (103/146) to 87.5% (98/112). Critically, all patients who required colonoscopy surveillance had been appropriately listed excluding four patients (2.4%) who were missed before introducing the web-bed decision guide. Conclusion: Using currently available technology, a web-based colonoscopy decision support tool that can generate recommendations according to the NHMRC colonoscopy guidelines was created. This improved the decision-making regarding the need for and timing of diagnostic, screening, or colonoscopy surveillance.