Background: Both patients and government demand proof of quality of care and value for money. Our unit ist in a large teaching hospital, performing over 6000 procedures per year. We have designed and implemented a Quality Assurance (QA) program, the basis of which we believe could be a model for endoscopy QA.
Methods: A QA team was formed and a literature search undertaken. An initial 3 month audit was then performed into indications for, and complications of, all procedures. The results of this initial audit led us to concentrate on colonoscopy and ERCP. The specific items of data collected were based on the „Core Quality Indicators“ developed by the American Society for Gastrointestinal Endoscopy (ASGE). We also analysed data relating to endoscope disinfection, equipment failure and carried out a patient satisfaction survey. The data were presented at 3-monthly QA meeting, and appropriate action taken.
Result: We performed a detailed audit of ERCP (217 procedures) and colonoscopy (904 procedures). Patients risk was stratified using the American Society of Anaesthesiology (ASA) classification. Using these data we established our technical success and complication rates for colonoscopy and ERCP. Audit of equipment revealed that on average an endoscope was away for repair 9 % of the time. Contamination of endoscopes was frequent with glutaraldehyde disinfection; the rate of contamination fell dramatically when we changed our disinfection method.
Conclusion: A QA program can be implemented in busy endoscopy units. There are significant problems, however, in ensuring that such a programm is effective: these include inadequate funding/staffing, lack of suitable information technology and lack of clear guidelines for dealing with poor performance.
References
-
1 American Society for Gastrointestinal Endoscopy Standards of Practice Committee. Quality assurance of gastrointestinal endoscopy. Manchester, MA; American Society for Gastrointestinal Endoscopy 1988
-
2 American Society for Gastrointestinal Endoscopy Ad Hoc Committee on Outcomes. Quality and outcomes assessment in endoscopy. Oak Brook, IL; American Society for Gastrointestinal Endoscopy 1998: (ASGE publication no. 1042; http://www.asge.org/gui/resources/manual/misc_quality_assessment.asp)
-
3
Eisen G M, deGarmo P, Brodner R, Leiberman D A.
Can the ASA grade predict the risk of endoscopic complications? [abstract].
Gastrointestinal Endosc.
2000;
51
AB 142
-
4
Freeman M L, Nelson D B, Sherman S. et al .
Complications of endoscopic biliary sphincterotomy.
N Engl J Med.
1996;
335
909-918
-
5
American Society for Gastrointestinal Endoscopy .
Appropriate use of gastrointestinal endoscopy.
Gastrointest Endosc.
2000;
52
831-837 (http://www.asge.org/gui/resources/manual/misc_appropriate_use_endo_00.asp)
-
6
Gonvers J J, Burnand B, Froehlich F. et al .
Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open access endoscopy unit.
Endoscopy.
1996;
28
661-666
-
7
Arrowsmith J B, Gerstman B B, Fleischer D E, Benjamin S B.
Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy.
Gastrointest Endosc.
1991;
37
421-427
-
8
Johanson J.
Procedure-specific outcomes assessment for colonoscopy.
Gastrointest Endosc Clin N Am.
1999;
9 (4)
625-637
-
9 Cotton P, Williams C. Practical gastrointestinal endoscopy. 4th ed. Oxford; Blackwell Science 1996
-
10
Loperfido S, Angelini G, Benedetti G. et al .
Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study.
Gastrointest Endosc.
1998;
48
1-10
-
11
Gottlieb K, Sherman S.
ERCP and biliary sphincterotomy-induced pancreatitis.
Gastrointest Endosc Clin N Am.
1998;
8
87-114
-
12
Freeman M L.
Procedure-specific outcomes assessment for endoscopic retrograde cholangiopancreatography.
Gastrointest Endosc Clin N Am.
1999;
9
639-647
-
13
Freeman M L, Nelson D B, Sherman S. et al .
Complications of endoscopic biliary sphincterotomy and their prevention.
N Engl J Med.
1996;
335
909-917
-
14
Mehta S N, Pavone E, Barkun J S. et al .
Predictors of post-ERCP complications in patients with suspected choledocholithiasis.
Endoscopy.
1998;
30
457-463
-
15
Sherman S, Lehman G, Freeman M L. et al .
Risk factors for post-ERCP pancreatitis: a prospective multicenter study [abstract].
Am J Gastroenterol.
1997;
92
1639
-
16
Johanson J F, Schmidt C.
Outcomes research for the private practice gastroenterologist.
Am Gastroenterol Assoc News.
1995;
31
6-8
-
17
Reiertsen O, Skjoto J, Jacobsen C D, Rosseland A R.
Complications of fiberoptic gastrointestinal endoscopy: five years’ experience in a central hospital.
Endoscopy.
1987;
19
1-6
-
18
Tanner A R.
ERCP - present practice in a single region: suggested standards for monitoring performance.
Eur J Gastroenterol Hepatol.
1996;
8
145-148
-
19
Schutz S M, Abbott R.
Grading ERCPs by degree of difficulty: a new concept to produce more meaningful outcome data [abstract].
Gastrointest Endosc.
1999;
49
AB 148
-
20
Rubin H R, Gandek B, Rogers W H. et al .
Patients’ ratings of outpatient visits in different practice settings; results from the Medical Outcomes Study.
JAMA.
1993;
270
835-840
-
21 ESGE Committee for Minimal Standards for Terminology and Documentation in Digestive Endoscopy. Minimal Standard Terminology for databases in digestive endoscopy: preliminary presentation for testing. Bad Homburg, Germany; Normed 1995
-
22
Delvaux M, Korman L Y, Armegnol-Miro J R. et al .
The Minimal Standard Terminology for digestive endoscopy: introduction to structured reporting.
Int J Med Inform.
1998;
48
217-225
-
23
Rockall T A, Logan R F, Devlin H B, Northfield T C.
Risk assessment after acute upper gastrointestinal haemorrhage.
Gut.
1996;
38
316-321
G. Naylor
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