Colorectal cancer screening in Canada 2021/2022

Strategies to reduce wait time from abnormal fecal test to colonoscopy follow-up

The wait time to follow-up colonoscopy provides information on the effectiveness of the referral system and the availability of the diagnostic procedure. Long wait times after an abnormal fecal test can be stressful for participants and can cause potentially worse screening outcomes in terms of stage of diagnosis.

Improving wait times is a priority for the Partnership and the National Colorectal Cancer Screening Network. Although wait times in jurisdictions have improved in recent years, no jurisdiction is currently meeting the national target, which is for 90% of eligible participants to receive a follow-up colonoscopy within 60 days of their abnormal test. However, all provinces and territories have strategies to meet this target.

Strategies being implemented to reduce the time from abnormal fecal test to colonoscopy follow-up

P/T Strategies to reduce wait times to colonoscopy following an abnormal fecal test
YT Colonoscopy Clinic:
· Increase in admin staff and experienced colonoscopists
· Dedicated endoscopy rooms
· Increase in colonoscopies to 4 days/week
· CPAC funding for colonoscopy equipment purchases and Knowledge Exchange softwareColonCheck:
· Notice to primary care providers to complete referral for positive FITs sent earlier – ongoing
· Repeated provider education and reminder letters – ongoing
· Follow-up with Surgeon’s Clinic if program has not received appointment date for colonoscopies – ongoing
NT* · Organized screening program in planning stages with view to decrease time from positive FIT to colonoscopy.
· Revised Booking forms for NT endoscopy sites that state the date of a positive FIT.
· Streamlining process from positive FIT to colonoscopy to reduce number of patient appointments and potential wait time.
NU* · Each region has specific workflows to coordinate results and follow-up as services for two regions are provided out of territory.
BC · Facilitated referral to Health Authorities for follow-up. Some HAs have patients complete a pre-colonoscopy assessment questionnaire, if deemed low risk patient, is booked direct to scope.
AB · Dedicated endoscopy slots.
· Regularly monitoring of follow-up colonoscopy uptake and wait time.
· Successful implementation of C-GRS provincial policy; mandate to improve endoscopy quality, including adherence to recommended wait times.
· Actively monitoring the impact COVID has on CRC screening and diagnostic follow-up. COVID 19 Pandemic Resumption Plan for Ambulatory Care distributed to all endoscopy sites regarding triage and prioritization of endoscopic slots during COVID.
· Currently updating the provincial post polypectomy surveillance recommendations, including revision of low risk adenoma surveillance which will reduce low yield colonoscopy volume.
SK · Dedicated endoscopy slots in most areas of the province.
· Screening program is a stakeholder in the CPAC funded project Managing Endoscopy Resources to Serve Patients Better.
· Strategies include establishing a centralized waitlist, scheduling, and documentation system (OR Manager) for endoscopy patients with endoscopy specific booking priority based on Canadian Association of Gastroenterology (CAG) guidelines which outline maximum wait times by acuity.
· Anticipated outcomes include improvement of procedure volumes, waitlisting, and booking for all patients to ensure all patients are seen within target wait times based on priority.
MB · With PCP permission, program will make direct referral to colonoscopy.
· Program has dedicated spots in Winnipeg, and triage processes in each of the other regional health authorities.
· In two of the five RHA, centralized intake manages direct referral.
ON · Developed a COVID-19 Regional Monitoring and Planning tool to help Regional Cancer Programs monitor and improve colonoscopy wait times for people with an abnormal fecal test.
· Developed COVID-19 tip sheets for PCPs and endoscopists to support the gradual resumption of colorectal cancer screening and increasing GI endoscopy services.
· Education for PCPs and endoscopists (e.g., Continuing Professional Development, FIT laboratory reports emphasizing timely follow-up, etc.).
· Completion of a pilot project to inform future strategies for improving follow-up (i.e., centralized navigation).
· Process for linking people without a regular PCP and an abnormal result to a PCP.
QC · Implementation of a standardized colonoscopy referral form with different priority levels.
· Implementation of a new remuneration system for endoscopy units to improve volume and diminish wait times.
· Implementation of the fast-track colonoscopy access which consists of scheduling a colonoscopy procedure by eliminating the need for patients to meet with a gastroenterologist for a pre-procedure appointment; they simply come in on the day of their procedure. Each patient will receive an initial consultation by phone with a nurse, who will assess the patient’s state of health and take charge of risk factors before the procedure. Once the assessment is completed, they will be scheduled for the procedure with a colonoscopist and will receive instructions for preparatory colon-cleansing agents.
NB · Integrated approach and centralized colon cancer screening program services.
· Dedicated endoscopy slots for FIT positive colonoscopies.
· Monitoring of screening program colonoscopy wait times and screening colonoscopy demand.
NS · Integrated approach and centralized colon cancer screening program services.
· Dedicated endoscopy slots for FIT positive colonoscopies.
· Monitoring and notification of screening program colonoscopy wait times and screening colonoscopy demand.
PE · Planning for diagnostic navigation plan.
· Monitoring of wait time in place and follow up with PCP for update on referral to colonoscopy.
NL · Program has dedicated colonoscopy time in 1 out of 4 health regions.
· Endoscopist completes the SEE program.
· Follow CAG guidelines.*
· Nurse navigation results in patients direct to colonoscopy.

NL: * Canadian Association of Gastroenterology