write some suggestions of ideas for a QI project/Audit in the Gastroenterology department as a final year medical student. It should be of good impact overall
Here are some high-impact QI project and audit ideas for a gastroenterology department, suitable for a final year medical student:
QI Project / Audit Ideas for Gastroenterology
1. Timely Endoscopy for Upper GI Bleeding (UGIB)
Type: Clinical Audit
- Audit whether patients presenting with acute UGIB receive endoscopy within 24 hours as per BSG/NICE guidelines.
- Measure pre-endoscopy Rockford/Glasgow-Blatchford score documentation.
- Impact: High - UGIB carries significant mortality; timely endoscopy is a key quality marker.
- Easy to run: Retrospective case note review using ICD-10 codes (K25, K92.0 etc.)
2. Appropriate Use of Proton Pump Inhibitors (PPIs)
Type: Prescribing Audit / QI
- Audit inpatient or outpatient PPI prescriptions for documented indication, dose appropriateness, and review dates.
- Many patients are on PPIs long-term without a clear indication or step-down plan.
- Impact: High - affects patient safety (C. diff risk, hypomagnesaemia, fractures), polypharmacy, and cost.
- Easy to run: Cross-sectional prescription review on any gastro ward or outpatient list.
3. IBD Monitoring - Biologics & NICE Compliance
Type: Clinical Audit
- Check whether patients on biologics (infliximab, adalimumab, vedolizumab) are having monitoring bloods (FBC, LFTs, CRP, TDM) at recommended intervals.
- Audit whether IBD nurse specialist is involved and if patient-held records/care plans exist.
- Impact: High - missed monitoring can lead to serious adverse events; biologics are expensive and tightly regulated.
4. Bowel Cancer Screening Pathway - Follow-Up After Positive FIT
Type: Pathway Audit
- Track the time from positive FIT test result to colonoscopy referral and completion.
- Compare against 2-week wait targets.
- Impact: Very high - delays in the bowel cancer pathway directly affect cancer stage at diagnosis and survival.
5. Documentation of Nutritional Screening (MUST Score) in GI Admissions
Type: Clinical Audit
- Audit whether MUST scores are completed on admission and repeated appropriately for GI inpatients (e.g., liver disease, IBD, GI malignancy).
- Check if dietitian referrals are made when indicated.
- Impact: Nutritional neglect in GI patients is common and affects outcomes. NICE QS24 mandates screening.
6. Inpatient Alcohol-Related Liver Disease (ALD) Care Bundle
Type: QI Project
- Implement or audit use of an ALD care bundle: Maddrey score, liver screen, alcohol history, Pabrinex, specialist referral, alcohol liaison nurse involvement.
- Impact: High mortality condition with clear evidence-based interventions that are frequently missed.
- Excellent scope for a PDSA cycle.
7. Colonoscopy Quality Indicators - Adenoma Detection Rate & Bowel Prep
Type: Endoscopy QI
- Audit adenoma detection rates (ADR) per endoscopist vs. BSG benchmarks (>25% in screening populations).
- Audit adequacy of bowel preparation (Boston Bowel Prep Scale documentation) and whether poor-prep cases are being rebooked appropriately.
- Impact: ADR is the strongest predictor of post-colonoscopy colorectal cancer.
8. Hepatitis C Cascade of Care
Type: Pathway / QI
- Audit rates of diagnosis, linkage to care, treatment initiation, and SVR12 testing in known Hep C patients.
- WHO targets: eliminate HCV by 2030 - many trusts are not on track.
- Impact: HCV is curable; identifying gaps in the cascade is highly actionable with direct patient benefit.
9. H. pylori Testing & Eradication Follow-Up
Type: Primary/Secondary Care Audit
- Audit whether patients prescribed H. pylori eradication therapy have confirmatory test-of-cure (stool antigen or urea breath test) documented at 4-6 weeks post-treatment.
- Impact: Missed test-of-cure leads to undetected treatment failure and persistent ulcer disease or cancer risk.
10. Post-Endoscopy Communication - Discharge Letters & Histology Follow-Up
Type: Patient Safety / QI
- Audit whether endoscopy discharge letters are completed, whether histology results are actioned, and whether patients are informed of biopsy results within a defined timeframe.
- Impact: Missed or delayed histology results is a recognised patient safety never-event category.
Tips for Your Project
| Factor | Advice |
|---|---|
| Data access | Retrospective audits using EPR/coding are faster to set up |
| Supervisor buy-in | Choose a topic your consultant already cares about |
| Cycle completion | Even a small intervention + re-audit looks impressive |
| Guidelines | Always anchor to BSG, NICE, or NCEPOD standards |
| Presentation | Most trusts have audit days - aim to present your findings |
Top picks for impact + feasibility as a student: #1 (UGIB timely endoscopy), #2 (PPI audit), or #5 (MUST nutritional screening) - all are well-scoped, have clear standards to audit against, and produce actionable results within a few weeks.
write more about the 1. Bowel Cancer Screening Pathway - Follow-Up After Positive FIT and 2. Colonoscopy Quality Indicators - Adenoma Detection Rate & Bowel Prep
Searching PubMed
bowel cancer screening FIT positive colonoscopy pathway timelines
Searching PubMed
adenoma detection rate colonoscopy quality indicators bowel preparation
Searching the Web
NHS bowel cancer screening programme FIT positive referral pathway 2024 2025 standards timelines
Searching the Web
BSG colonoscopy quality indicators adenoma detection rate bowel prep guidelines 2024
Reading Web Page
FIT positive pathway timelines colonoscopy standards adenoma detection rate bowel prep
Reading Article
Excellent - I now have solid, up-to-date material. Here is a detailed write-up of both projects:
1. Bowel Cancer Screening Pathway - Follow-Up After Positive FIT
Background & Rationale
The NHS Bowel Cancer Screening Programme (BCSP) invites everyone aged 50-74 in England to complete a Faecal Immunochemical Test (FIT) every two years. FIT detects human haemoglobin in stool using specific antibodies - a positive result indicates possible lower GI bleeding and triggers referral for colonoscopy.
In January 2025, the programme expanded to include 50 and 52-year-olds, significantly increasing the volume of invitations and positive results flowing through endoscopy units. Uptake has risen from 59% to around 65-66% since FIT replaced guaiac-based testing in April 2019.
The critical issue is what happens after a positive FIT result. Delays at any point in the pathway - result notification, referral, appointment booking, or colonoscopy completion - directly affect the stage at which cancer is diagnosed and, consequently, survival.
The Standards You Would Audit Against
| Standard | Source | Target |
|---|---|---|
| Urgent 2-week wait colonoscopy following positive FIT | NICE NG12 / BCSP | Colonoscopy within 14 days of referral for suspected cancer pathway |
| Colonoscopy within BCSP pathway | BCSP Programme Standards | Colonoscopy offered within 31 days of positive FIT result |
| Cancer waiting times (62-day) | NHS England | Treatment within 62 days of screening referral |
| Symptomatic FIT threshold (lower GI symptoms) | BSG/ACPGBI 2022 | Referral if FIT ≥10 µg Hb/g faeces |
Note: There are two different FIT pathways - the screening FIT (population invitation, threshold ~80-120 µg Hb/g in England) and the symptomatic FIT (GP-requested for lower GI symptoms, threshold ≥10 µg Hb/g). Both are auditable, but the symptomatic pathway often has more gaps.
Specific Aims for the Audit
- Time from positive FIT to colonoscopy appointment: How many patients breach the 31-day or 2-week wait standard?
- Did-not-attend (DNA) rates: What proportion of positive FIT patients did not attend colonoscopy, and was there documented follow-up?
- Completeness of bowel prep instructions: Were patients given adequate preparation advice before colonoscopy?
- Downstream outcomes: Of those scoped, what was the proportion found to have cancer, high-risk adenomas, or normal findings?
- Inequalities: Are there socioeconomic or demographic differences in who follows through to colonoscopy? (This is a known gap - uptake is lower in deprived populations.)
How to Run It
- Data source: Bowel Cancer Screening System (BCSS) / trust endoscopy database / JAG Endoscopy reporting system
- Case identification: Pull all positive FIT results over a 6-12 month period; cross-reference with endoscopy bookings
- Retrospective review: Track each patient from FIT result date to colonoscopy date; flag breaches
- Standard: BCSP pathway standards and NICE NG12
QI Component (Making It a PDSA Cycle)
If the audit shows significant delays, a QI intervention could include:
- A dedicated FIT-positive tracking spreadsheet or escalation pathway managed by the bowel screening coordinator
- A patient reminder SMS/letter system for those who have not booked within 2 weeks of referral
- A re-audit 3-6 months after the intervention to close the loop
Why This is High Impact
- Colorectal cancer is the 4th most common cancer in the UK and the 2nd leading cause of cancer death
- Stage at diagnosis is the single biggest predictor of survival: 5-year survival is >90% at stage I but falls to <10% at stage IV
- Pathway delays are a known, modifiable cause of late-stage diagnosis
- This topic aligns with NHS England's priority to improve cancer waiting time performance, which has been consistently below target in recent years
2. Colonoscopy Quality Indicators - Adenoma Detection Rate & Bowel Prep
Background & Rationale
The quality of a colonoscopy is not uniform. A colonoscopy performed by an endoscopist with a low adenoma detection rate (ADR) carries a meaningfully higher risk of a patient developing cancer between screening episodes - so-called post-colonoscopy colorectal cancer (PCCRC). Quality indicator monitoring is therefore a patient safety issue, not just a performance metric.
The BCSP mandates a rolling programme of audit at all screening centres, and the Joint Advisory Group on GI Endoscopy (JAG) sets national standards.
Key Quality Indicators and Their Standards
1. Adenoma Detection Rate (ADR)
Definition: The proportion of colonoscopies where at least one adenoma is detected.
| Population | Minimum Standard | Source |
|---|---|---|
| Unselected/mixed | ≥25% | ESGE (European Society) |
| Post-FIT/screening | ≥35% | ACG 2024 Quality Indicators |
| Surveillance | ≥40-43% | Real-world data (Fernandes et al., Endoscopy 2025) |
A landmark 2025 systematic review and meta-analysis (Fernandes et al., Endoscopy, PMID 39227020) pooled data from 3.6 million subjects across 31 studies and found:
- Overall pooled ADR: 26.5% (95% CI 23.3-29.7%) - just above the ESGE 25% benchmark
- Post-FIT screening ADR: 34.4% - considerably higher, reflecting a pre-selected higher-risk population
- Surveillance ADR: 42.9%
- Male sex and older age were significantly associated with higher ADR
This confirms the 25% benchmark for unselected populations is appropriate, but also supports the argument that separate benchmarks by indication, sex, and age may be needed going forward.
Why ADR matters: Each 1% increase in ADR is associated with a 3% reduction in the risk of interval colorectal cancer and a 5% reduction in interval cancer mortality.
2. Caecal Intubation Rate (CIR)
Definition: The proportion of colonoscopies where the caecum is reached and photographically documented.
| Standard | Target |
|---|---|
| BCSP / JAG | ≥90% for all cases; ≥95% for elective cases |
If the caecum is not reached, the right colon (where serrated lesions and flat adenomas are common) is not examined. Low CIR is a direct patient safety risk.
- Audit angle: Is the caecal intubation rate documented with photographic evidence (as required by BCSP)? Are cases where the caecum was not reached being appropriately rebooked or referred for CT colonography?
3. Bowel Preparation Adequacy
Definition: Quality of bowel cleansing, typically scored using the Boston Bowel Preparation Scale (BBPS) - total score 0-9, with ≥6 considered adequate (≥2 per segment).
| Standard | Target |
|---|---|
| BCSP | Adequate prep documented in all procedures |
| BSG / ESGE | Inadequate prep cases should be rescheduled within 1 year |
Poor bowel preparation is the single most common reason for a missed adenoma and for incomplete colonoscopy. A 2024 meta-analysis (PMID 39138737) compared oral sulfate solution vs PEG for bowel prep - both are acceptable but patient adherence to split-dose regimens is a known audit gap.
Audit angles:
- Is BBPS documented for every colonoscopy in your unit?
- What proportion of procedures have inadequate prep, and is this being recorded?
- Are patients with inadequate prep being rescheduled within 12 months as per guidance?
- Are high-risk patients (e.g. those on GLP-1 receptor agonists, opioids, or with slow-transit constipation) being identified and given enhanced prep advice in advance?
Note: A 2025 meta-analysis (PMID 40121157) highlighted that GLP-1 receptor agonists (e.g. semaglutide/Ozempic) significantly worsen bowel preparation quality - with the explosion in GLP-1 prescribing, this is a very timely audit target.
4. Withdrawal Time
Definition: Time spent inspecting the mucosa during scope withdrawal.
| Standard | Target |
|---|---|
| BSG / JAG | Mean withdrawal time ≥6 minutes |
Shorter withdrawal times are directly correlated with lower ADR. Auditing withdrawal time documentation and comparing per-endoscopist data against this benchmark is straightforward using JAG/endoscopy reporting data.
5. Polyp Retrieval Rate
Definition: Proportion of polyps removed that are successfully sent for histology.
| Standard | Target |
|---|---|
| BCSP | ≥90% |
Missing histology = missed pathology. If a polyp is removed but not retrieved, surveillance intervals cannot be correctly assigned.
6. Post-Colonoscopy Colorectal Cancer (PCCRC) Rate
Definition: Cancers diagnosed within 36 months of a negative or incomplete colonoscopy.
| Standard | Target |
|---|---|
| JAG / BCSP | PCCRC-3yr rate <7.4% of all CRC |
This is harder to audit as a student (requires cross-referencing cancer registry data) but is worth mentioning as the clinical outcome that all other quality indicators ultimately seek to prevent.
How to Run This as an Audit
- Data source: JAG Endoscopy reporting system (Global Rating Scale / JETS), endoscopy unit activity data, histology records
- For ADR: Pull all colonoscopies over 3-6 months; identify those with at least one adenoma reported in histology; calculate per-endoscopist and overall ADR
- For bowel prep: Check whether BBPS score is documented on every procedure report; identify cases with BBPS <6 and check if they were rebooked
- For CIR: Check endoscopy reports for caecal photographic documentation
- For withdrawal time: Pull procedure duration data from the endoscopy system
QI Interventions Worth Testing
| Problem Found | Possible Intervention |
|---|---|
| Low ADR in some endoscopists | Feedback sessions; water-jet assisted colonoscopy; cap-assisted colonoscopy |
| Poor bowel prep documentation | Standardise endoscopy report template to mandate BBPS score entry |
| Inadequate prep not being rebooked | Create a dedicated pathway/flag in the system for BBPS <6 → auto-rebook |
| GLP-1 patients with poor prep | Pre-procedure checklist to identify GLP-1 use and offer enhanced prep |
| Short withdrawal times | Individual feedback with peer comparison data |
Why This is High Impact
- The ADR is the strongest single predictor of post-colonoscopy cancer risk
- JAG data shows significant variation in ADR between endoscopists in real UK units - there is a known quality gap to close
- Bowel prep inadequacy results in repeated procedures, wasted NHS resources, and patient inconvenience
- GLP-1 agonists are now among the most widely prescribed drugs in the UK - their effect on bowel prep is an emerging and under-audited issue
- Any improvement in these indicators has a direct downstream effect on colorectal cancer mortality
Summary Comparison
| Feature | FIT Pathway Audit | Colonoscopy Quality Audit |
|---|---|---|
| Complexity | Moderate | Moderate-High |
| Data access | BCSS / endoscopy booking systems | JAG / endoscopy reporting |
| Time to complete | 4-6 weeks retrospective | 4-8 weeks retrospective |
| Clinical guidelines | BCSP, NICE NG12 | JAG, BSG, ESGE |
| Impact if gaps found | Direct effect on cancer stage at diagnosis | Direct effect on interval cancer rates |
| PDSA potential | Tracking/reminder system | Report template standardisation |
| Best for presentation | Trust cancer waiting time boards | Endoscopy governance / audit meetings |
Both are publishable-quality projects for a final-year student if completed rigorously - the FIT pathway audit is slightly more accessible logistically, while the colonoscopy quality audit gives richer clinical depth and aligns with ongoing national JAG accreditation work.
The audit is done in Bulgaria (Europe) so can we follow the standards/guidelines set in Europe
Searching the Web
ESGE European colonoscopy quality indicators guidelines 2024 adenoma detection rate standards
Searching the Web
European colorectal cancer screening programme FIT positive pathway guidelines ESGE EU council recommendation 2022 2023
Searching PubMed
ESGE colonoscopy quality indicators European guidelines
Searching the Web
Bulgaria colorectal cancer screening programme FIT colonoscopy gastroenterology guidelines
Now I have what I need - including specific Bulgarian context. Here is the fully revised guide anchored to European guidelines:
Adapting Both Audits to Bulgaria - European Standards & Guidelines
Key Point on Bulgaria's Context
Bulgaria is an EU Member State and is therefore subject to EU Council recommendations on cancer screening and the European Guidelines for Quality Assurance in Colorectal Cancer Screening and Diagnosis (European Commission, first edition). Importantly, Bulgaria has only recently launched a national CRC screening programme - the Bulgarian Ministry of Health announced a national FIT-based CRC programme in autumn 2025, offering free FIT kits to individuals aged 45-75 under its National Cancer Control Plan 2023-2030. Prior to this, no organised national screening programme existed. This makes both audit topics particularly timely and high-impact for a Bulgarian gastroenterology setting.
The primary European bodies whose guidelines you should cite are:
| Body | Abbreviation | Role |
|---|---|---|
| European Society of Gastrointestinal Endoscopy | ESGE | Colonoscopy quality standards, endoscopy guidelines |
| European Commission / IARC | EC/IARC | EU quality assurance guidelines for CRC screening |
| United European Gastroenterology | UEG | European GI policy and practice |
| Council of the European Union | EU Council | 2022 recommendation on cancer screening across member states |
| European Society for Medical Oncology | ESMO | CRC oncology guidelines (used in Bulgaria's own PTG) |
Project 1: Bowel Cancer Screening Pathway - Follow-Up After Positive FIT
European Guideline Framework
EU Council Recommendation (2022)
The 2022 EU Council Recommendation on cancer screening replaces the 2003 recommendation and formally designates quantitative FIT as the preferred screening method for individuals aged 50-74 across member states. It mandates that positive FIT results are followed by diagnostic colonoscopy within an organised, integrated pathway with defined timelines and quality assurance.
European Guidelines for Quality Assurance in CRC Screening (EC/IARC)
The EU's own quality assurance guidelines (developed with experts from 32 countries) set out the following principles relevant to this audit:
| Principle | Standard |
|---|---|
| Organised, population-based programme | Must use personal invitation system with individual tracking |
| FIT threshold (screening) | Typically ≥10-20 µg Hb/g for symptomatic; higher thresholds for screening populations |
| Follow-up after positive FIT | Colonoscopy must be offered in a timely manner - EU guidelines recommend no undue delay, with many member states using a 30-60 day benchmark |
| Screening registry | All results, referrals, and outcomes must be recorded in a screening registry |
| Quality assurance monitoring | Regular audit of the cascade from positive FIT to colonoscopy outcome is mandatory |
ESGE Bowel Prep & Pathway Guidance
ESGE guidelines specify that colonoscopy following a positive FIT should be performed to a high technical standard (adequate prep, complete examination) given the higher pre-test probability of significant pathology in this group.
What to Audit in Bulgaria
Given that Bulgaria's national FIT programme has only just launched (autumn 2025), an audit of the FIT-to-colonoscopy pathway is exceptionally well-timed. You could focus on:
Option A - Hospital/Endoscopy Unit Level
If the national programme is not yet fully operational in your centre, audit the opportunistic/symptomatic FIT pathway instead - i.e., patients referred by GPs with lower GI symptoms who have a positive FIT:
| Audit Question | European Standard to Cite |
|---|---|
| Time from positive FIT result to colonoscopy | EU QA Guidelines: no undue delay; benchmark 4-6 weeks |
| Was FIT threshold correctly applied? | EU/ESGE: ≥10 µg Hb/g for symptomatic patients |
| Was the colonoscopy technically complete? | ESGE: caecal intubation required; BBPS ≥6 |
| Was histology obtained and documented? | EU QA Guidelines: mandatory tissue sampling and recording |
| Was the patient informed of results? | EU QA Guidelines: written communication of outcome required |
| Was appropriate surveillance arranged post-polypectomy? | ESGE Post-Polypectomy Surveillance Guidelines (2020) |
Option B - New Programme Baseline Audit (if launched locally)
If the national programme is running at your hospital, this is a rare opportunity to do a baseline audit of a brand-new pathway, measuring:
- What proportion of screen-positive patients actually proceed to colonoscopy (conversion rate)
- Time from FIT result letter to colonoscopy date
- Patient DNA (did-not-attend) rates and whether recall was attempted
- Adequacy of colonoscopy performed on screen-positives
Suggested Standards Table for Your Audit Proforma
| Indicator | Standard | Source |
|---|---|---|
| Colonoscopy after positive FIT within 6 weeks | ≥90% | EU QA Guidelines / local programme target |
| Colonoscopy completion (caecal intubation) | ≥90% | ESGE |
| Adequate bowel preparation documented | ≥90% | ESGE |
| Histology sent for all polypectomy specimens | 100% | ESGE / EU QA Guidelines |
| Post-procedure letter/communication to patient | 100% | EU QA Guidelines |
| Post-polypectomy surveillance recommendation documented | 100% | ESGE Surveillance Guidelines |
Project 2: Colonoscopy Quality Indicators - ADR & Bowel Prep
European Guideline Framework (ESGE)
The ESGE Quality Improvement Initiative is the primary European standard for colonoscopy quality. Key ESGE documents to cite:
- ESGE Quality Improvement Initiative (2014, updated) - sets minimum standards for colonoscopy
- ESGE Post-Polypectomy Surveillance Guidelines (2020)
- ESGE Guideline on Bowel Preparation for Colonoscopy
Quality Indicators with European Standards
1. Adenoma Detection Rate (ADR)
| Standard | Target | Source |
|---|---|---|
| Minimum ADR (unselected population) | ≥25% | ESGE Quality Improvement Initiative |
| ADR in screening population (post-FIT) | ≥34-35% | Real-world data (Fernandes et al., Endoscopy 2025, PMID 39227020) |
| ADR in surveillance | ≥43% | Same meta-analysis |
The 2025 systematic review and meta-analysis (Fernandes et al.) pooled 3.6 million patients from 31 real-world studies and confirmed the ESGE 25% benchmark is appropriate for unselected populations, while suggesting higher targets by indication. This is the most current and directly relevant evidence base.
Note on US vs European standards: The US ACG/ASGE 2024 guidelines raised the ADR target to ≥35% for all outpatient colonoscopies - this is higher than the current ESGE minimum of 25%. In your Bulgarian audit, cite ESGE (25% minimum) as the primary standard. You can reference the 2025 meta-analysis and the US update as evidence that 25% may be a floor rather than a target, strengthening your argument for improvement if your ADR is low.
2. Caecal Intubation Rate (CIR)
| Standard | Target | Source |
|---|---|---|
| All colonoscopies | ≥90% | ESGE |
| Elective/screening colonoscopies | ≥95% | ESGE |
Mandatory photographic documentation of the caecum (ileocaecal valve and appendiceal orifice) is required by ESGE for every colonoscopy.
3. Bowel Preparation Adequacy
| Standard | Target | Source |
|---|---|---|
| Adequate bowel preparation (BBPS ≥6, or equivalent) | ≥90% of outpatient procedures | ESGE |
| Inadequate prep cases rescheduled | Within 1 year | ESGE |
Score to use: The Boston Bowel Preparation Scale (BBPS) is the ESGE-recommended scoring tool. Score is 0-9 across three colon segments; a total score ≥6 (with no segment scoring 0) is considered adequate.
Timely audit hook - GLP-1 agonists: A 2025 meta-analysis (PMID 40121157) showed that GLP-1 receptor agonists (semaglutide, liraglutide - increasingly prescribed in Bulgaria for obesity and type 2 diabetes) significantly worsen bowel preparation quality. Auditing whether patients on GLP-1 agonists are being identified pre-procedure and given enhanced prep instructions is a novel, clinically relevant angle.
4. Withdrawal Time
| Standard | Target | Source |
|---|---|---|
| Mean withdrawal time | ≥6 minutes | ESGE |
This is one of the most straightforward indicators to audit - simply pull mean withdrawal times per endoscopist from the endoscopy reporting system.
5. Polyp Retrieval Rate
| Standard | Target | Source |
|---|---|---|
| Polyps sent for histology | ≥90% | ESGE / EU QA Guidelines |
6. Post-Colonoscopy CRC (PCCRC) Rate
| Standard | Target | Source |
|---|---|---|
| PCCRC at 3 years | <7.4% of all CRC diagnoses | WEO / ESGE |
Harder to calculate as a student, but worth mentioning as the clinical outcome all other indicators protect against.
Suggested Audit Proforma for Colonoscopy QI in Bulgaria
For each colonoscopy performed over your audit period (suggest 3-6 months of data), collect:
| Data Field | What to Record |
|---|---|
| Endoscopist ID | For per-endoscopist analysis |
| Indication | Screening / surveillance / diagnostic / post-FIT |
| Caecal intubation achieved? | Yes/No + photographic documentation? |
| BBPS score | Total and per-segment |
| Withdrawal time (minutes) | From procedure report |
| Number of polyps found | Including morphology/size |
| Adenoma confirmed on histology? | Yes/No |
| Histology sent for all polyps? | Yes/No |
| Post-procedure plan documented? | Surveillance interval recommended? |
Then calculate for your unit:
- Overall ADR = (colonoscopies with ≥1 adenoma) ÷ (total eligible colonoscopies) × 100
- CIR = (colonoscopies reaching caecum) ÷ (all colonoscopies) × 100
- Adequate prep rate = (colonoscopies with BBPS ≥6) ÷ (all outpatient colonoscopies) × 100
Why This is Especially Relevant in Bulgaria Right Now
- Bulgaria's national CRC programme is brand new (2025) - establishing baseline quality data now is directly useful for the programme's quality assurance framework
- CRC incidence in Bulgaria is among the highest in the EU - making quality colonoscopy a public health priority
- ESGE standards are the natural benchmark for any Bulgarian gastroenterology department - they are the pan-European gold standard and are what accreditation systems in other EU member states use
- No prior established QI culture in Bulgarian endoscopy means your audit may be genuinely novel for your department, giving it real local impact beyond a tick-box exercise
Summary: European Guidelines to Cite for Each Audit
| Guideline | Used For |
|---|---|
| EU Council Recommendation on Cancer Screening (2022) | FIT programme framework and follow-up mandate |
| European Guidelines for QA in CRC Screening (EC/IARC) | FIT-to-colonoscopy pathway standards |
| ESGE Quality Improvement Initiative | ADR, CIR, withdrawal time, bowel prep |
| ESGE Bowel Preparation Guideline | BBPS scoring, rescheduling policy |
| ESGE Post-Polypectomy Surveillance Guideline (2020) | Surveillance recommendations post-procedure |
| Fernandes et al., Endoscopy 2025 (PMID 39227020) | Real-world ADR benchmarks by indication |
| Bulgaria National Cancer Control Plan 2023-2030 | Local policy context for the screening programme |
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