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Colonoscopy Care

Colonoscopy Completion Rate

What are we measuring?

The percentage of colonoscopies which are completed. A completed colonoscopy is one in which the tip of the colonoscope is extended into the cecum, so that the endoscopist can view the area to detect any lesions or polyps. This is sometimes referred to as the cecal intubation rate. At BIDMC, we track completion rates for both screening colonoscopies and all colonoscopies. Note: Hospitals use different ways to calculate rates. We calculate our rates using 100 patient procedures as the denominator.

Why is this important?

Achieving safe cecal intubation improves the accuracy of diagnosis, and can remove the need for a follow-up examination or a second colonoscopy to complete the study. Studies have shown that cecal intubation rates above 90% are achieved by experienced providers.

What is BIDMC's performance?

Source of performance data is BIDMC Administrative Databases
Source of Benchmark: Rex, Douglas, et al, Quality in the Technical Performance of Colonoscopy and the Continuous Quality Improvement Process for Colonoscopy: Recommendations of the US Multi-Society Task Force on Colorectal Cancer, American Journal of Gastroenterology, 2002

What are we doing to improve?

Patient safety and comfort during the colonoscopy is procedure is essential. Some patients who have experienced incomplete colonoscopies under moderate sedation benefit from BIDMC's ability to provide anesthesia when medically appropriate.  This capability reduces patient discomfort and allows the endoscopist the time to perform a complete inspection of the colon for lesions and polyps, and to take appropriate therapeutic action. This can also reduce the need for patients to undergo follow-up colonoscopies.

Colonoscopy Complication Rate

What are we measuring?

The overall serious complication rate for colonoscopies performed at BIDMC. Serious complications include perforation of the colon, or bleeding that requires transfusion.

Why is this important?

With any procedure, one of the biggest concerns for patients is post-procedure complications. Serious complications such as perforations of the colon or bleeding may require immediate medical interventions, transfusions, or return to the hospital.

What is BIDMC's performance?

Source of performance data is BIDMC Administrative Databases
Source of Benchmark: Levin, Theodore R., et al, Complications of Colonoscopy in an Integrated Health Care Delivery System, Annals of Internal Medicine, 19 December 2006

What are we doing to improve?

Patient involvement and education is a key element of patient safety. At BIDMC, all patients undergoing colonoscopies are provided with information about their procedure prior to their appointment to ensure that they can properly prepare.

At the time of procedure, BIDMC has implemented a series of steps and activities designed to ensure patient safety, including:

  • Pre-procedure "time out" to verify correct patient, correct procedure, correct position; 
  • Verbal "read back" verification between the endoscopist and nursing team members of equipment settings used during the removal of polyps as appropriate; 
  • Careful monitoring of patients during the procedure and immediately afterward during post recovery. Most patients undergo moderate sedation for the procedure, so to ensure patient safety and comfort all patients are monitored closely during their procedure as well as post procedure recovery, and anesthesiologists are available if needed; and
  • To ensure the safety and comfort, specialized tables and equipment are provided for patients with specific medical needs.

Additionally, BIDMC's routinely monitors its performance, using a broad list of quality and safety performance measures (including the measures presented here) to ensure compliance with recommended guidelines and nationally recognized benchmarks. This data is reviewed quarterly by the Division leadership for quality and safety.

Colonoscopy Polyp Detection Rate

What are we measuring?

The number of adenomatous polyps found and removed per initial screening colonoscopy.

Why is this important?

There are different types of polyps, but adenomatous polyps or adenomas are the important ones as they have the potential to grow and eventually turn into cancer over time. The reason we perform colonoscopy is so that we can remove these polyps when they are small before they have a chance to turn into cancer or grow so large that they are difficult to take out. For this reason finding and removing as many adenomas as possible per colonoscopy is a major part of assessing the quality of the procedures.

What is BIDMC's performance?

Source of performance data is BIDMC Administrative Databases
Source of benchmark data: Quality indicators for colonoscopy and the risk of interval cancer.  Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wojciechowska U, Didkowska J, Zwierko M, Rupinski M, Nowacki MP, Butruk E. N Engl J Med. 2010 May 13;362(19):1795-803.

What are we doing to improve?

We continue to monitor adenoma detection rates with changes in equipment and endoscopists to ensure we continue to exceed national benchmarks.

Learn about Patient Satisfaction with GI Care
Learn about ERCP Care

Last Updated:  October 6, 2011

Contact Information

Silverman Institute for Health Care Quality and Safety
Beth Israel Deaconess Medical Center
330 Brookline Ave
Boston, MA 02215