Reduced waiting times and a lower cost are just two of the benefits for patients accessing the Direct Access Colonoscopy (DAC) service in South Western Sydney. 

Available at both Campbelltown and Liverpool hospitals, DAC is a streamlined, specialised nurse-led service which enables rapid access to a public hospital colonoscopy for patients who return a positive Faecal Occult Blood Test (FOBT).

Patients have a telehealth appointment with a DAC nurse who guides them through the process of having a colonoscopy.

This comprehensive assessment includes discussing the reasons, benefits and risks of having a colonoscopy and providing bowel preparation instructions, as well as completing their admission forms and scheduling their colonoscopy.  

They do not need to see a specialist prior to their colonoscopy which helps reduce barriers such as taking time off work to attend face-to-face appointments and out of pocket expenses. The service also improves wait times for the procedure. 

Each hospital has a clinical lead who oversees the running of the service – Dr Ken Koo at Liverpool Hospital and Associate Professor Ian Turner at Campbelltown Hospital. The DAC service is run by clinical nurse consultant Nada Vujasin and clinical nurse specialists Karen Williams and Dhanya Jacob. 

Dr Koo explains: “We have developed a clinical pathway that ensures a safe and effective, patient-centred service. The clinical leads oversee the running of the service while providing clinical support and supervision to our DAC nurses on all matters relating to patient care and the service”. 

“This nurse-led clinic helps ensure rapid access to a colonoscopy, bypassing the need to first see a specialist,” Dr Koo said. “The fact that it reduces the cost involved with seeing a specialist and time off work to attend the appointment is an important consideration in South Western Sydney. 

“Our nurses are excellent patient navigators and are readily accessible and contactable by patients and GPs alike. This service also frees up space in the public hospital clinic for patients with more complex medical problems,” Dr Koo said. 

The service was first established in 2016 at Liverpool and Campbelltown hospitals with the assistance of a grant offered by the Cancer Institute of NSW.  

Residents of Liverpool and Fairfield local government areas can attend Liverpool Hospital for their procedure, while those living in Campbelltown, Camden, Wingecarribee and Wollondilly go to Campbelltown Hospital. Planning is underway to include Bankstown Hospital, anticipated to commence in late 2025. 

To be eligible, patients must have a Medicare card, a positive FOBT or bowel cancer screening test, be aged between 45 and 75 years old and reside in the relevant local government areas.  

The patient’s GP completes a referral form which contains a list of clinical criteria to determine their eligibility. The clinical leads and DAC nurses then assess the completed form, and suitable patients are scheduled an appointment with one of the DAC nurses.  

Patients with health issues who are not suitable for the DAC service will be scheduled to see the clinical lead at their respective clinics prior to having their colonoscopy. 

Dr Koo said the service offered by DAC service was important because bowel cancer was the second leading cause of cancer-related death in Australia.  

“This highlights the need for proactive screening,” Dr Koo said. “It helps detect early bowel cancer or precancerous lesions, often before they cause any noticeable symptoms. Early detection is the key as it significantly increases the chances of successful surgery and ultimately improves survival.” 

SWSPHN Chief Executive Officer, Dr Keith McDonald PhD, said increasing the level of screening was a key priority in a region which had a low participation rate. 

“In 2022 to 2023 the annual bowel cancer participation rate for people aged 50 to 74 in South Western Sydney was only 33.8 per cent,” Dr McDonald said. “Bowel cancer is increasing in people under 50 and there is a need to increase participation in the screening program, especially in the younger portion of the target group. 

“Encouragement and guidance from GPs in normalising screening behaviour has been shown to increase participation.” 

Direct Access Colonoscopy referral form