Quality control of colonoscopy procedures: A prospective validated method for the evaluation of professional practices applicable to all endoscopic units (original) (raw)
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Annals of Surgical Treatment and Research
Purpose: Colonoscopy is an effective method of screening for colorectal cancer (CRC), and it can prevent CRC by detection and removal of precancerous lesions. The most important considerations when performing colonoscopy screening are the safety and satisfaction of the patient and the diagnostic accuracy. Accordingly, the Korean Society of Coloproctology (KSCP) herein proposes an optimal level of standard performance to be used in endoscopy units and by individual colonoscopists for screening colonoscopy. These guidelines establish specific criteria for assessment of safety and quality in screening colonoscopy. Methods: The Colonoscopy Committee of the KSCP commissioned this Position Statement. Expert gastrointestinal surgeons representing the KSCP reviewed the published evidence to identify acceptable quality indicators and indicators that lacked sufficient evidence. Results: The KSCP recommends an optimal standard list for quality control of screening colonoscopy in the following 6 categories: training and competency of the colonoscopist, procedural quality, facilities and equipment, performance indicators and auditable outcomes, disinfection of equipment, and sedation and recovery of the patient. Conclusion: The KSCP recommends that endoscopy units performing CRC screening evaluate 6 key performance measures during daily practice.
Expert opinions and scientific evidence for colonoscopy key performance indicators
Gut, 2016
Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards.
Quality Assurance and Colonoscopy
Endoscopy, 1999
Little is known concerning the usefulness and feasibility of quality assurance pro grams in gastrointestinal departments. The aim of this study was to identify the indicators of quality in colo noscopy, to check their use in clinical practice, and to identify their threshold values.
Quality indicators in colonoscopy. The colonoscopy procedure
Revista Espanola De Enfermedades Digestivas, 2018
The aim of the project this paper is part of was to propose quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. In this second issue, procedures and indicators are suggested regarding colonoscopy. First, a diagram charting the previous and subsequent steps of colonoscopy was designed. A group of experts in health care quality and/or endoscopy, under the auspices of the Sociedad Española de Patología Digestiva (SEPD), performed a qualitative review of the literature regarding colonoscopy-related quality indicators. Subsequently, using a paired-analysis method, the aforementioned literature was selected and analyzed. A total of 13 specific indicators were found aside of the common markers elsewhere described, ten of which are process-related (one pre-procedure, seven procedure, and two post-procedure markers) while the remaining three are outcome-related. Quality of evidence was assessed for each one of them using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) classification.
Cureus, 2021
Introduction Quality metrics of colonoscopy should be routinely monitored with a focus on optimizing the patient's subsequent risk of colorectal cancer development. Documentation of bowel preparation, adenoma detection rate (ADR), and post-colonoscopy follow-up recommendations are three of the most important quality indicators for colonoscopy, but significant improvement has been challenging to achieve. The goal of this study is to determine whether the publication of colonoscopy quality indicator guidelines in 2015 resulted in an improvement in quality measures of physicians in our endoscopy suite as compared to before. Methods We reviewed the electronic medical records of patients who underwent a screening or surveillance colonoscopy in 2014 and 2017. Colonoscopies were performed in an open-access medical center endoscopy suite, staffed by three groups of physicians (academic gastroenterologists (AGs), non-academic gastroenterologists (non-AGs), and surgeons). We gathered demographic data, bowel preparation reports, follow-up recommendations, and notice to patient's primary care physician, and calculated ADR for patients. Age-and gender-matched patients in both years were analyzed for ADR. These data were further subcategorized for each group of physicians. Results There were 553 patients in 2014 and 1,095 in 2017. Overall, male gender and African American race constituted the majority of patients in both years. Among age-and gender-matched patients in 2014 and 2017 (412 and 243 patients, respectively), ADR within each group of endoscopists was not significantly different between these two years (AGs 44% vs. 50%; non-AGs 32% vs. 27%; surgeons 25% vs. 21%; p>0.05 for all). However, in 2014 and 2017, ADR was significantly higher in the AG group as compared to the non-AG group and surgeons (p<0.006 and p<0.0004, respectively). Reporting of bowel preparation quality (82% vs. 87%) and documenting the recommended period for follow-up surveillance colonoscopy in the report (68% vs. 78%) improved between 2014 and 2017 (p=0.002 and p=0.0001, respectively). Correct recommendations for follow-up surveillance colonoscopy only improved significantly in the AG group (74% in 2014 as compared with 82% in 2017, p=0.003). Conclusion Based on the current guidelines, AG physicians are far exceeding the target ADR goals, and are superior compared to other groups of endoscopists. Although improvements were noted after guideline publications, areas of needed improvement with respect to meeting gastroenterology society guidelines for quality remained. The fact that individual physicians are performing and billing in an endoscopy suite staffed and equipped by a medical center creates an environment where responsibility for improvement in quality cannot be readily assigned.
Effectiveness of a continuous quality improvement program on colonoscopy practice
Endoscopy, 2007
Colonoscopy is regarded as the gold standard for detection of colorectal neoplasia, and increasing− ly considered a primary screening approach for colorectal cancer . Colonoscopy, however, may fail to detect clinically important neoplastic lesions. Three large retrospective studies [2 ± 4] and one population−based analysis consist− ently showed that, in routine clinical practice, miss rates for colorectal cancer at colonoscopy range from 2 % to 6 %. With regard to adenoma detections, experienced endoscopists in the Na− tional Polyp Study failed to identify approximate− ly 25 % of patients with incidental adenomas . In tandem colonoscopy studies, the pooled miss rate for polyps of any size was 22 % [7]. There is also evidence that the sensitivity of colonoscopy for colorectal neoplasia varies among centers and examiners, and this reflects variations in its qual− ity performance . Improving the quality of the technical perform− ance of colonoscopy is a mandatory goal for en− hancing the impact of the examination on the de− tection and prevention of colorectal cancer. An integral part of any program of quality improve− ment is the identification and measurement of specific quality indicators that are associated with desirable outcomes. Once these indicators have been elucidated, benchmarks must be de− veloped for use as comparators. Benchmarks pro− vide both a threshold level for acceptable per− formance as well as an optimal level for use as a goal for performance improvement . In 2002, the US Multi−Society Task Force on Colo− rectal Cancer identified specific quality indica− tors for colonoscopy and, for each of them, estab− lished threshold levels that could be targets for Background and study aim: Continuous quality improvement (CQI) is recommended by profes− sional societies as part of every colonoscopy pro− gram, but little is known with regard to its effec− tiveness for colonoscopy outcomes. We prospec− tively assessed whether the implementation of a CQI program in routine clinical practice influen− ces the quality performance of colonoscopy.