Endoscopy Services

As a follow on to its capacity survey, the Network, in collaboration with the NSW Department of Health's Clinical Services Redesign Program carried out a six week comparison study into the efficiency of colonoscopy provision across six public hospitals and two private hospitals between November - December 2006. The purpose of the Colonoscopy Study was to compare identified models of care in terms of their standard of care, level of throughput efficiency and demand-capacity matching.

In 2007 a joint NSW Health / GMCT Gastroenterology Network's Colonoscopy Study Implementation Committee was established to implement the main findings of the Colonoscopy Study. This committee which is co-chaired by Michael Bourke (Gastroenterologist, Westmead Hospital) and Donald MacLellan (NSW Health) includes clinicians, Area Health Service representatives, the Clinical Excellence Commission and consumer participation.

In 2007 the Colonoscopy Study Implementation Committee developed new advice on the appropriate clinical priority categories for elective colonoscopy procedures for referring and treating doctors managing elective patients and waiting lists in NSW public hospitals. The new advice was developed following extensive consultation with a wide variety of stakeholders including gastroenterologists, surgeons, Area Health Service representatives, the NSW National Bowel Cancer Screening Program Advisory Group and the NSW Health Surgical Services Taskforce and will be included in the revised guidance to accompany the next edition of the NSW Health "Waiting Time and Elective Patient Management Policy" which will be published in 2008.  The overall aims of the new advice are to clarify the appropriate clinical priority categories for colonoscopies and to promote the National Health and Medical Research Council's 2005 clinical practice guidelines for the prevention, early detection and management of colorectal cancer.  Increasing awareness about the appropriate surveillance intervals for repeat procedures should help to avoid excessive or unnecessary surveillance procedures being conducted, with subsequent benefits in terms of increasing capacity and cost savings and improvements in the quality and safety of procedures provided.

Concerned with inequities in access to anaesthetic services for gastrointestinal endoscopy in NSW public hospitals, the Network established a Sedation Working Party in November 2006. In addition to clinicians from the Network and consumer participation, this working party included invited representatives from the following Colleges / Societies:

• Australian and New Zealand College of Anaesthetists (ANZCA)
• Gastroenterological Society of Australia (GESA)
• Royal Australasian College of Surgeons (RACS)
• Australian Society of Anaesthetists (ASA)
• Joint Consultative Committee on Anaesthesia (JCCA)

The working party met three times between November 2006 and March 2007.

A Federal conjoint committee which included representatives of ANZCA, RACS and GESA met twice between November 2007 and January 2008 to discuss necessary changes to existing guidelines on sedation for gastrointestinal endoscopic procedures to facilitate the training of non anaesthetist medical practitioners and allow the grandfathering of those experienced in procedural sedation and analgesia.