Bowel cancer is the fourth most diagnosed cancer in Australia.
The good news is that approximately 90% of cases can be successfully treated if the cancer is detected early.
A faecal occult blood test (FOBT+) is commonly used as a screening test to help find bowel cancer, also known as colorectal cancer, before you have symptoms.
If patients do return a positive screening result, the next step is a specialist consultation before a colonoscopy, which can then provide a formal diagnosis.
Health services across Victoria have long faced significant challenges in providing timely access to colonoscopy services due to high demand and long waitlists. Labour-intensive processes have historically impacted access to consultant and procedural care for diagnosis.
All this has been exacerbated by post-pandemic referral surges.
Making an IMPACT
To tackle these challenges, our Gastroenterology team, led by Associate Professor Sally Bell, and in partnership with the Transformation team, developed the IMPACT (Improving Management and Procedural Access for Colorectal Tumours) program.
The IMPACT program, established in 2023, introduces a direct access pathway to colonoscopy following a positive FOBT+ result. This eliminates the need for a preliminary specialist consultation.
This new model of care includes nurse-led, digitised assessment, bowel prep instructions and medication management, patient choice in colonoscopy timing, and streamlined post-procedure follow-ups, all under the supervision of gastroenterology consultants.
This patient-centred approach ensures that those most at risk, particularly those with an FOBT+ result, receive prompt care.
The program has shortened the time from referral to colonoscopy and improved periprocedural medication safety and bowel prep compliance using simplified, language-specific stepped instructions.
The results
Our Endoscopy service cares for over 12,500 patients annually. Inspired by successful models from other Australian states, the program has already shown impressive results.
Over the program’s first six months, 279 patients were invited to participate, and 239 were accepted – an engagement rate of 86%.
For those 239 patients, the time from referral to colonoscopy completion was reduced from an average of 137 days to 24 days.
The program’s success is measured through ongoing data monitoring, patient satisfaction surveys, and feedback, ensuring continuous improvement.
Contingent on ongoing funding, the subsequent phases will focus on enhancing discharge and communication with referring doctors. The team will also look to expand the scope to include all colonoscopy referrals at Monash Health, with the potential to extend to gastroscopy referrals.
The work of the Gastroenterology team has been nominated for the ‘Excellence in value-based health care’ category at the 2024 Victorian Public Healthcare Awards. Entries have now closed, and the finalists will be announced in September.