Quality monitoring in colonoscopy: Time to act

Table 1 Colonoscopy screening and surveillance guidelines

Finding	Advised interval
No polyps/adenomas	10 yr
Single first degree relative with cancer (or adenomas) ≥ 60 yr	10 yr (begin age 40)
Two or more first degree relatives with cancer (or adenomas) or one first degree relative diagnosed ≤ 60 yr	5 yr (begin age 40)
Few (1-2), small tubular adenomas (< 1 cm)	5 yr
Advanced adenomatous lesions (> 1 cm or villous histology or high grade dysplasia) or > 3 adenomas	3 yr
Numerous (> 10) adenomas	Individualized approximately < 3 yr
HNPCC	1-2 yr (begin age 20-25)
Sessile adenomas > 2 cm, removed piecemeal	2-6 mo
Post cancer resection surveillance	Clear colon, then 1 yr, then 3 yr, then 5 yr

Joint guidelines from the American Cancer Society, the United States Multi-Society Task Force on Colorectal Cancer, and the American College of radiology. HNPCC: Hereditary nonpolyposis colorectal cancer.

Table 2 Healthcare quality improvement projects[46]

Plan-Do-Study-Act (P-D-S-A)

Employs cycles of planning (P), small scale pilot testing (D), analysis of test results and lessons learned (S), followed by incorporation and maintenance of new processes into practice (A)

Useful when resources and time are limited and rapid stepwise improvement is desired

Lean method

Seeks to increase efficiency and reduce waste by excluding all processes, steps, or inputs that fail to contribute value to the end product

Useful when existing practices are deemed to be inefficient and cumbersome, with bottlenecks and excessive rework

Employs collaborative team input and process revision through value stream mapping

Six Sigma method

Intensively data driven approach to minimizing variation and thereby reducing defects or errors to improve quality

Use a cyclic approach referred to as the Define-Measure-Analyze-Improve-Control method

Employs more rigorous analytical tools and process control charting under the guidance of local experts

Especially appropriate for repetitive high frequency processes