Value In Care – optimising surveillance COLonoscopy (VIC-COL) in Victorian healthcare services

What is VIC-COL?

VIC-COL is a collaborative program of work shared between three Victorian Academic Health Science Centres (Monash Partners, Western Alliance, and Melbourne Academic Centre for Health) aimed at improving high-value use of colonoscopy in Victorian public hospitals. It is supported by grants from the Victorian Department of Health and Human Services Healthcare Recovery Initiative and HCF Foundation.

Lead by Prof Denise O’Connor and Prof Harriet Hiscock, VIC-COL brings together an interdisciplinary team of research translation experts, clinical leaders in colonoscopy care, consumer partners and key state/ national stakeholders, including representatives from the Australian Commission on Safety and Quality in Health Care (ACSQHC), Choosing Wisely Australia, Safer Care Victoria, Victorian Perioperative Consultative Council and the Department of Health Victoria.

Lead Investigators

  • Prof Denise O’Connor, Monash University
  • Prof Harriet Hiscock, Murdoch Children’s Research Institute

Co-Investigators

  • Prof Karin Thursky, Peter MacCallum Cancer Centre
  • Prof Alison Hutchinson, Deakin University
  • Prof Martin Hensher, University of Tasmania
  • A/Prof Alexandra Gorelik, Monash University
  • Prof Ralph Audehm, University of Melbourne
  • Prof Andrew O’Loughlin, Federation University
  • Prof Grant Russell, Monash University
  • Dr Jonathan Foo, Monash University
  • Dr Corey Joseph, Monash Health
  • Dr Danielle Berkovic, Monash University
  • Dr Sean Docking, Monash University
  • A/Prof Alan Moss, Western Health
  • Dr Radha Nair, Central Gippsland Health Service
  • Dr Sophie Ping, East Grampians Health Service

Project Experts and Consumer Representatives

  • A/Prof Gregor Brown, Alfred Hospital
  • Prof Anne Duggan, Australian Commission on Safety and Quality in Health Care
  • Prof Jon Emery, University of Melbourne
  • Ms Susan Shedda, Royal Melbourne Hospital
  • Ms Marilyn Dolling, Consumer Representative
  • Ms Annie Paliwal, Consumer Representative

Project Support

  • Dr Natasha Davidson, Monash University
  • Dr Corey Joseph, Monash Health
  • Ms JC Han, Monash University

VIC-COL hospitals participate in regular audits of surveillance colonoscopy cases, and receive evidence-based feedback on their concordance with the NHMRC-endorsed Cancer Council Australia Guidelines for surveillance colonoscopy1. In addition, we hold interactive, educational workshops with participating sites to discuss surveillance colonoscopy guidelines, site and endoscopist feedback reports, and barriers to quality improvement with Australian leaders in endoscopy. Participating sites nominate a clinical champion to conduct audits, monitor concordance and support local quality improvement activities.

VIC-COL Intervention Resources

  1. Audit and Feedback Training Guide (PDF)
  2. Audit Tool (Qualtrics) (PDF)
  3. Spreadsheet for Documenting Guideline Concordance (xlsx)
  4. Hospital Feedback Templates: i) First report, ii) Second/subsequent report (docx)
  5. Endoscopist Feedback Templates: i) First report (docx), ii) Second/subsequent report (docx)
  6. Quick Reference Guide for Cancer Council Australia Surveillance Colonoscopy Guidelines (PDF)
  7. VIC-COL Clinical Champion PD (PDF)

Why do we need VIC-COL?

Surveillance colonoscopy has an instrumental role in early detection of precancerous polyps and prevention of colorectal cancer in patients at increased risk. Yet the procedure is sometimes carried out unnecessarily or too frequently in normal to low risk patients who are unlikely to benefit, and not frequently enough in higher risk patients who will benefit most. The optimisation of surveillance colonoscopy in line with best practice guidelines will reduce the risk of procedural harm related to unnecessary procedures, reduce wait times for those who would receive benefit, and promote timely detection and treatment of bowel cancer.

A 20% improvement in guideline concordance of surveillance colonoscopy intervals is expected to result in ~ 15% reduction in colonoscopy procedures over the next 10 years, thus providing better access for necessary, timely procedures.

Hospitals that participate in VIC-COL fulfil partial requirement for accreditation with the National Safety and Quality Health Service Standard (NSQHS) and ACSQHC. Participating endoscopists can credit time spent reviewing VIC-COL feedback reports, reviewing cases and attending VIC-COL workshops towards AHPRA continuing professional development requirements.

Key Resources

NHMRC-endorsed Cancer Council Australia Guidelines for Surveillance Colonoscopy – Current Australian guidelines for surveillance colonoscopy, including detail on how to appropriately recommend surveillance colonoscopy intervals.

NHMRC-endorsed Cancer Council Australia Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer – Current Australian clinical practice guidelines on population screening for the prevention, early detection, and management of colorectal cancer.

Polyp.app – A free online decision support tool to assist endoscopists in determining guideline-concordant surveillance colonoscopy intervals.

Safer Care Victoria Best Care Guidance – Outline of the Best Care resources for surveillance colonoscopy.

ACSQHC Colonoscopy Clinical Care Standard – 2020 Clinical Care Standard for colonoscopy, including a statement on the importance of appropriate and timely surveillance.

ACSQHC Clinical Care Standard Fact Sheet – A simplified fact sheet for clinicians outlining the statements in the 2020 clinical care standard for colonoscopy.

ACSQHC Follow-Up Letter Template from to GP and Patient – A letter template (docx) provided by ACSQHC to support endoscopists in communicating intervals with GPs and their patients.

ACSQHC – How to Reduce Bowel Cancer Risk – Fact sheet targeted towards patients informing them of steps to reduce their bowel cancer risk.

Cancer Data in Australia – A short summary of cancer cases in Australia including demographics, prevalence and survival rates.

Where can I go if I have questions?

Please contact the VIC-COL team via viccol.study@monash.edu for more information or to discuss any questions regarding VIC-COL. For specific clinical questions, please contact your hospital clinical lead.

References

  1. Cancer Council Australia (2018). Cancer Council Australia Surveillance Colonoscopy Guidelines Working Party Clinical practice guidelines for surveillance colonoscopy. https://wiki.cancer.org.au/australia/Guidelines:Colorectal_cancer/Colonoscopy_surveillance
  2. Fitzsimmons, T., et al. (2022). Assessing the impact of the 2019 National Health and Medical Research Council polyp surveillance guidelines on compliance with surveillance intervals at two public hospitals. ANZ Journal of Surgery.
  3. Baraty B, Wang H, Zhou D, Wu P, Szczesniak M, Craig P, Choo L. Non adherence to NHMRC post polypectomy surveillance intervals in an Australian tertiary institution. J of Gastro and Hepatol 2016; 31(Suppl. 2):8-28.