BowelScreen considered ‘penalties’ to improve CIR data

The BowelScreen programme has considered “financial penalties” for endoscopy units that fail to submit complete data on the caecal intubation rate (CIR) for colonoscopies.

In January 2025, the programme’s clinical advisory group (CAG) heard there had been “recent improvements” in the receipt of data. However, a number of units had not submitted data or the data was incomplete. 

If this issue persisted, the programme would “consider financial penalties” to ensure receipt of the requested information, stated the CAG minutes obtained under Freedom of Information law.

The CIR is the proportion of colonoscopy procedures where the caecum was reached. A low CIR is associated with an increased risk of interval colorectal cancer, according to the programme’s Standards for Quality Assurance in Colorectal Screening. Incomplete colonoscopy leads to increased costs and inconvenience as the examination must be repeated.

There is a quarterly reporting period for the CIR, with rolling 12-month data reported three months in arrears.

The CIR and adenoma detection rate (ADR) data are reviewed quarterly by the BowelScreen Clinical Director and nursing staff. The CIR is one of the core key performance indicators (KPIs) with regard to quality assurance of endoscopy services in the programme.

The caecum should be reached in at least 90 per cent of colonoscopies and the achievable standard is 95 per cent and above, according to the quality standards.

The CIR data for 73 endoscopists during 2023 was presented at the CAG meeting in March. Some 68 endoscopists met the KPI. The actions taken regarding five endoscopists who did not meet the KPI were discussed at the meeting, but details were not included in the minutes.

A BowelScreen spokesperson said: “In adherence with our quality standards, endoscopists who carry out colonoscopies for our BowelScreen programme are expected to meet our caecal intubation rate and adenoma detection rate as outlined in our quality standards.”

The spokesperson said two of the five endoscopists are no longer on the programme’s endoscopist register. Three of the endoscopists were just below the CIR standard and had their CIR and ADR performances reviewed by the BowelScreen Clinical Director. Their performance was found to be satisfactory and continues to be monitored as part of the quality assurance process.

Bowel screening aims to detect signs of bowel cancer at an early stage when there are no symptoms. BowelScreen is free for everyone aged 59 to 70. In 2022/23, the screening uptake rate was 46.4 per cent – below the target of 50 per cent. The spokesperson said a range of initiatives are underway to help improve uptake.