Abstract
Background and Aims. A colonoscopy triage sheet (CTS) integrating 6 hierarchical scheduling priorities based on indications for screening, surveillance, or symptoms was designed for colonoscopy referral. We compared CTS priority ratings by referring physicians and endoscopists, assessing yields. Methods. Retrospective study of consecutive patients. Data were collected on demographics, CTS and endoscopist priority ratings, and endoscopic findings. Weighted kappa values measured interrater agreement on priority assignment. Predictors of agreement and lesions were identified using multivariable analysis. Results. Among 1230 patients (60.3 years, 52.5% female), clinically significant lesions included tumors (1.1%), polyps per patient ≥ 10 mm (7.6%), and ileocolitis (4.6%). Moderate agreement was found between referring physician and endoscopist on all 6 priorities (weighted kappa 0.55 (0.51; 0.59)). P4 and P5 ratings predicted increased agreement (range of OR for P4: 2.47–4.57; P5: 1.58–2.93). Predictors of clinically significant findings were male gender (OR 1.44, 1.03–2.03) and P1/P2 priorities that were significantly superior to P3 (OR = 2.14; 1.04–4.43), P4 (OR = 2.90; 1.35–6.23), and P5 (OR = 4.30; 2.08–8.88). Conclusion. Priority-assignment agreement is moderate and highest for less urgent ratings. Predictors of clinically significant findings validate the hierarchal priority scheme. Broader validation and physician education are needed.
Highlights
Colorectal cancer (CRC) is a major cause of death worldwide
Over the 6-month study period, among the 3576 referral requests for colonoscopies, we identified 1230 successive patients with completely filled outpatients referral sheets that comprised the study population
The colonoscopy triage sheet (CTS) was constructed based on colonoscopy clinical guidelines issued by the Quebec Ministry of Health [5] and published waiting time recommendations by the Canadian Association of Gastroenterology [2]
Summary
Colorectal cancer (CRC) is a major cause of death worldwide. Colorectal cancer is the third most commonly diagnosed cancer in Canada (excluding nonmelanoma skin cancers) and it is the second leading cause of death from cancer in men and the third leading cause of death from cancer in women in Canada [1]. Based on the CAG guidelines and in the context of an Open-Access Endoscopy system (without a prior clinic consultation with the endoscopist), a 1-page colonoscopy triage sheet (CTS) was developed for the entire province to improve the quality, efficiency, and equitable delivery of Canadian Journal of Gastroenterology and Hepatology all colonoscopy services. The CTS captures all pertinent clinical information (symptoms or screening/surveillance indication) and medical history as recorded by the referring physician, as well as a section that allows flagging patients who require a prior consultation in person because of existing comorbidities (e.g., need for anticoagulation). We compared CTS priority ratings by referring physicians and endoscopists, assessing yields. Moderate agreement was found between referring physician and endoscopist on all 6 priorities (weighted kappa 0.55 (0.51; 0.59)). Predictors of clinically significant findings validate the hierarchal priority scheme.
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