当前位置: 首页 > 期刊 > 《英国医生杂志》 > 2004年第22期 > 正文
编号:11354139
Colonoscopy completion rates
http://www.100md.com 《英国医生杂志》
     EDITOR—We agree that the more time the better, and ideally we could lengthen our appointments still further. Royal college guidance is clear, but few data are adhered to and discussions with other consultants and trainees show that appointment times vary considerably and trainees do not always have adequate time for training. Our report was true for our unit and the 20 minute appointments were historical. Clearly adequate arrangements need to be made for trainees and guidelines should be followed by having a well-performing trainer present at all times with trainees until their performance is good enough for independent practice.

    This now happens in our unit, and trainees are not excluded from colonoscopy. However, colonoscopy training should be undertaken only by those with sufficient time and at an appropriate time in their career to learn this skill. With the reduction in training times resulting from the European Working Time Directive, some groups of trainees may not choose to learn colonoscopy.

    Patient selection is clearly important, with function being more important than age. Simply changing the ward on which inpatients receive their preparation, rather than increasing the number of inpatient preparations, should have no cost implications. Computed tomography may replace colonoscopy in some instances. Space prevented us from detailing other changes, but we did upgrade our colonoscopy equipment, which may have played an additional part.

    The issue of retraining v concentrating colonoscopy in the hands of those more successful is raised by Laban and Elewa and by others on bmj.com.1 We offered further training to everyone and did not compel anyone to give up colonoscopy. Some people chose to concentrate on other aspects of their career, and presumably they were in the best position to know whether it was likely that retraining would be effective. If the more successful colonoscopists stop doing simple procedures and concentrate on colonoscopies then the total number of colonoscopy appointments available might well go up so it is not merely a quick fix.

    Mark R Welfare, senior lecturer

    North Tyneside General Hospital, North Shields NE29 8NH doctormarkw@aol.com

    Competing interests: None declared.

    References

    Electronic responses. Quality improvement programme to achieve acceptable colonoscopy completion rates. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7467/665 (accessed 17 Nov 2004).