Unit registration
Colonoscopist registration
Procedure data collection
General queries


Unit registration

I want to register but I do not have an access code?

In order to create a layer of security for the sign up process, access codes have only been sent to the people in your endoscopy department who took an active role in the Global Rating Scale. It will be their responsibility to either register the unit themselves or nominate an audit lead to register the unit. We suggest you make contact with the endoscopy lead for your unit in the first instance.

A further password will be generated as part of the registration process which will apply to all users in your unit.

There is more than one site in my trust. Can I combine them?

It would be better to register the sites separately. Once registered, all sites can be accessed from the same login. Part of the remit of this project is to map colonoscopy site provision as well as colonoscopist expertise and get a feel for the output of 1, 2 and 3 room units in an average week.

It may be appropriate to merge sites in some circumstances. This is being dealt with on a case by case basis. Please use Contact Us if you have a query.

I am having problems with "Save and return later."

If, during unit registration, you should decide to click the Save and Return Later button, it is very important that the next time you login you should do so using the Login tab and not the Register Unit tab. Otherwise you may need to re-enter all the data you had previously saved.


Colonoscopist registration

I perform colonoscopy at more than one site. Does that cause a problem with registration?

A colonoscopists details should be entered for every site at which they practice colonoscopy. However a colonoscopist should only have one "main site" or base unit; this will avoid their data being counted more than once when the workforce data is analysed.

Should I only count colonoscopies performed in the NHS when counting how many procedures I have performed in the last 12 months?

No. When calculating the number of procedures performed in the last 12 months you should include all procedures irrespective of the site at which they were performed. Thus colonoscopies performed in the private sector should be included.


Procedure data collection

Why is the procedure data collection paper based?

A paper based data collection was considered the only satisfactory method. Unfortunately the technology is not currently in place to satisfactorily take the data directly from the various reporting tools used in endoscopy units in the UK. In addition, the data should be collected in the room at the time of colonoscopy by a third party (ie not the endoscopist) and they may not have a computer terminal available to them. Retained paper data collection sheets will also play an important role in quality assurance following the audit period.

I do not understand the trainee section of the data collection sheet.

The trainee section of the data collection sheet is only relevant for non-independent trainees ie a colonoscopist who is being trained by you. In some circumstances this may be an independent trainee or a consultant who is having some refresher training.

If a colonoscopist is not being directly supervised (ie in the room supervision) they should be considered independent. Thus their details should be entered on the colonoscopist registration page of the website.

In addition there was a small typing error in the first version of the datasheet which has caused some confusion. This has now been corrected. A new version of the datasheet is available for download on the Background page of the website.

I conduct evening endoscopy lists in my unit, how can these be differentiated from a PM (afternoon) list?

We have added an (EVE) evening option to the KPI datasheet to allow for the separate recording of routine evening colonoscopy activity. This option will also be available electronically at the time of upload.

How quickly do I need to enter my data onto the website?

Transfer of the data, collected on the paper form, onto the website should occur within one working day of the data being collected. This equates to 24 hours, except on friday when 72 hours will be allowed. Failure to do this will trigger contact from your regional leads to ensure you are not encountering problems.

I will only perform a few procedures during the audit period. Does that matter?

The audit has been geared to collect data at a national level. Specifically, there will be insufficient time to collect representative data on individual performance; this was never the intention of the project. Therefore even if an individual performs only a handful of procedures during the audit period they remain relevant and thus should be recorded.

What is the difference between screening and surveillance colonoscopy?

For the purposes of this audit a screening colonoscopy refers to a colonoscopy for people with a higher than average lifetime risk but without prior diagnosis of colonic disease. These groups include those with hereditary polyposis syndromes and a family history (FH) of colorectal cancer. 

Surveillance refers to a procedure for a patient with known current or previous colonic disease who is at higher risk of colorectal cancer.  For example, surveillance for a prior or current diagnosis of adenomas, colorectal cancer or IBD.

If a patient has had a screening colonoscopy for FH and is found to have polyps we recommend the next procedure is designated surveillance.  If no polyps are found then the next procedure for FH should be designated screening.

Colonoscopies performed as part of the National Bowel Cancer Screening Program should be entered using that specific indication rather than generic "Screening."

When should a colonoscopy be described as a BCSP (B) procedure?

Any procedure which arises from a positive FOBT test within a programme-based (national) screening programme should be designated BCSP (B).  The term screening (Sc) is intended to be used for colonoscopies done for high risk groups (usually for family history) when symptoms (D) or surveillance (Su) are not the main reasons for doing the procedure.

I use an opiate other than fentanyl or pethidine for colonoscopy. How do I record that?

If you are using alternative opiate analgesics such as alfentanil or tramadol, you should record this on the paper KPI datasheet using the first letter of the drug and the dose i.e. (A) for alfentanil. We have included these extra drug options on the electronic version of the datasheet to allow accurate recording of sedation use in every unit.

I use propofol sedation. How do I record this?

As a result of this question an option to record propofol sedation has been added to the sedation section as an alternative to conscious sedation, general anesthetic and no sedation.

The reasons available to explain an incomplete procedure are too limited.

Following feedback from the service we have created two new reasons for failure to reach the caecum:  severe IBD / colitis (I) and equipment failure (E).  The data sheet has been amended accordingly.

When does abdominal pain become a complication?

For pain to be considered a complication it would need to be severe and persistent enough to keep the patient in the department for much longer (at least an hour longer) than would be routine, or pain which requires further assessment or investigation such as plain abdominal film. A few windy gripes which have settled by discharge and do not concern the nursing staff or the doctor would not be considered a complication.  If a procedure is discontinued due to abdominal pain, but that pain resolves once the scope is removed, then that is not considered a complication but it should be cited as the reason for failure to complete the procedure.

Should a procedure be included in the audit if the intention at the outset is to perform a limited colonoscopy?

Strictly speaking, and certainly for the purposes of this audit, a procedure should only be scheduled and recorded as a colonoscopy if the intention at the outset is to complete the procedure to the caecum and/or ileum.  There will be circumstances (such as for planned therapy of a previously identified lesion) when a complete colonoscopy is unnecessary.  These procedures should NOT be included in the audit.  Thus, before a procedure starts, the colonoscopist and nurse (who will be recording the data) should agree on whether the procedure is a colonoscopy defined by an intention to complete.

Confirming caecal intubation

A complete colonoscopy is a procedure where caecal intubation is achieved. Confirmation of caecal intubation relies on visualisation of the anatomical features, or landmarks in the caecum and terminal ileum.

The most reliable methods for confirming caecal intubation are either terminal ileal intubation or direct visualisation of the ileo-caecal valve.  Identification of the tri-radiate fold or the appendix is less reliable. Transillumination through the abdominal wall and finger indentation of the right iliac fossa are not appropriate methods for confirming completion.

It is recommended that a photograph be taken of the most reliable landmark identified.

For the purposes of this study the accepted methods of confirming completion are ranked as follows:

1          Terminal ileal or neo-terminal ileal intubation

2          Visualisation of the ileo-caecal valve

3          Visualisation of the appendix or tri-radiate fold

Why can I only enter one diagnosis?

For speed and simplicity please enter only the principal diagnosis. This should be the endoscopic diagnosis of greatest clinical significance. We appreciate that patients will frequently have more than one diagnosis.

For example, in a patient where polyps and a cancer are diagnosed cancer is the more significant diagnosis. Likewise, in a patient with polyps and diverticular disease, polyps are the more significant diagnosis.

Which polyps should I count and which should I not?

For the purposes of this study, the following should not be entered as “polyps”:


      Post inflammatory polyps in IBD

      Small hyperplastic polyps in the rectum

How do I avoid an incomplete data set?

The aim of the KPI data sheet is to capture as much relevant data as possible (including key performance indicators) without making the process of data collection too arduous or time consuming. The KPI datasheet was designed by national ‘experts’ and modified following feedback from the service. The dataset is comparable to the minimum dataset of a standard endoscopy report.


It will not be possible to upload procedural data unless it is complete. If there is a gap in the data, this needs to be corrected, rather than discarding the procedure.  Having gaps in the data can be avoided by ensuring the endoscopist and nurse review the datasheet together at the end of the endoscopy list. Once they are satisfied that there are no missing data and no errors, they should both sign the datasheet.  All data sheets must be kept for future audit in case there are subsequent concerns about data quality.

General queries

Does this study truly represent actual practice? Colonoscopists will be aware they are being monitored and thus will alter their practice. This might influence things like ensuring completion to caecum in-spite of patient discomfort. 

When a person knows their performance is being monitored they are likely to behave differently - the so called Hawthorne effect.  The key questions are first, how big will this effect be?  Second, is this change in behaviour likely to harm patients? Third, does an effect matter in the context of this type of audit?

1.      It is not anticipated that there will be a substantial change in practice because we would expect most colonoscopists to perform to the best of their ability all the time.  If they could change their performance substantially for the better during an audit, one should question what they are doing the rest of the time. If the audit shows much better performance than usual practice (and this would be quite easy to check in a few randomly selected services) then this better performance would set the standard which services should aim for, or exceed in their regular practice.

2.      The requirement to measure sedation and comfort in the GRS and in this audit, and the withdrawal of consent policy in the GRS, provides a balance against excessive pushing to achieve higher completion.  These requirements will minimise the chance of harm to patients arising solely from the audit.  The audit is, of course, also measuring harm resulting from the procedure.  Our prediction is that harm will be less than previously published rates from the UK

3.      The principal purpose of the audit is to determine whether colonoscopy has improved since the last national audit.  Colonoscopists knew their performance was being measured at that time so the Hawthorne effect was operating then.  The magnitude of the effect is unlikely to be different now. So a Hawthorne effect operating in comparable audits should not bias differences between the audits.

Please note: It is important that case selection is unaffected by the audit and that all persons who perform colonoscopy should participate unless they are on annual or study leave for the audit.

How will we know that the data is complete?

The aim ofthis audit is to obtain as complete a picture of current colonoscopy practiceas possible. To achieve this we need data on all procedures performed, irrespectiveof outcome.  The more complete thedataset, the more credibility the eventual results will have.

We plan toaudit 10% of units by making a comparison between the total number ofcolonoscopies uploaded to the website and the number of colonoscopies performedduring the audit period and recorded on the local reporting system. This auditwill enable us to estimate the completeness of the dataset.  

How will I record complications which do not occur on the day of the procedure?

Late complications will be recorded in the third phase of the audit. Participating units will need to collect data on any patients readmitted within eight days of their procedure (8-day readmission rate) and on any patient who should die within 30 days of their procedure (30 day mortality). There will be a facility to upload this data onto the website.

Why does the system reject incomplete data? Are cases with incomplete data to be discarded?

No, we don't want discards but if we permit incomplete data entry we will get just that, which will defeat our objective. WE WANT TO ACHIEVE COMPLETE DATA COLLECTION FOR BOTH WEEKS OF THE AUDIT!.

IT IS A QUESTION OF MIND SET AND ENGAGEMENT. So far the response has been fantastic and it would be a pity to go off the boil at the final key stage.

If the nurse collects the data and the endoscopist checks completeness and fills in any blanks from the endoscopy report/system, downloading the entry from the KPI form to the audit site will take less than 2 minutes per patient. IT IS THAT SIMPLE!

Audit leads should emphasise the importance and ease of this approach.

We will audit 10% of sites for completeness of capture of colonoscopies and subsequently validate all sites against HES data.

This and future national audits will be key JAG accreditation measures.