CC BY 4.0 · Endoscopy 2023; 55(09): 812-819
DOI: 10.1055/a-2069-6588
Original article

High quality colonoscopy: using textbook process as a composite quality measure

Karlijn J. Nass
1   Department of Gastroenterology and Hepatology, Research Institute Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
,
Sascha C. van Doorn
2   Department of Gastroenterology and Hepatology, Flevo Hospital, Almere, The Netherlands
,
Paul Fockens
1   Department of Gastroenterology and Hepatology, Research Institute Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
3   Department of Gastroenterology, Bergman Clinics, Amsterdam, The Netherlands
,
Colin J. Rees
4   Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
,
Maria Pellisé 
5   Gastroenterology Department, Endoscopy Unit, ICMDiM, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Catalonia, Spain
,
Manon van der Vlugt
1   Department of Gastroenterology and Hepatology, Research Institute Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
3   Department of Gastroenterology, Bergman Clinics, Amsterdam, The Netherlands
,
Evelien Dekker 
1   Department of Gastroenterology and Hepatology, Research Institute Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
3   Department of Gastroenterology, Bergman Clinics, Amsterdam, The Netherlands
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Colonoscopy performance measures: going all in?Endoscopy 2023; 55(09): 820-821
DOI: 10.1055/a-2101-9045

Abstract

Background High quality colonoscopy is fundamental to good patient outcomes. “Textbook outcome” has proven to be a feasible multidimensional measure for quality assurance between surgical centers. In this study, we sought to establish the “textbook process” (TP) as a new composite measure for the optimal colonoscopy process and assessed how frequently TP was attained in clinical practice and the variation in TP between endoscopists.

Methods To reach consensus on the definition of TP, international expert endoscopists completed a modified Delphi consensus process. The achievement of TP was then applied to clinical practice. Prospectively collected data in two endoscopy services were retrospectively evaluated. Data on colonoscopies performed for symptoms or surveillance between 1 January 2018 and 1 August 2021 were analyzed.

Results The Delphi consensus process was completed by 20 of 27 invited experts (74.1 %). TP was defined as a colonoscopy fulfilling the following items: explicit colonoscopy indication; successful cecal intubation; adequate bowel preparation; adequate withdrawal time; acceptable patient comfort score; provision of post-polypectomy surveillance recommendations in line with guidelines; and the absence of the use of reversal agents, early adverse events, readmission, and mortality. In the two endoscopy services studied, TP was achieved in 5962/8227 colonoscopies (72.5 %). Of 48 endoscopists performing colonoscopy, attainment of TP varied significantly, ranging per endoscopist from 41.0 % to 89.1 %.

Conclusion This study proposes a new composite measure for colonoscopy, namely “textbook process.” TP gives a comprehensive summary of performance and demonstrates significant variation between endoscopists, illustrating the potential benefit of TP as a measure in future quality assessment programs.

Table 1 s, 2 s, Fig. 1 s



Publication History

Received: 06 May 2022

Accepted after revision: 04 April 2023

Accepted Manuscript online:
05 April 2023

Article published online:
22 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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