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Original Article

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Quality of Reporting in Upper Gastrointestinal Endoscopy: Effect of a Simple Audit Intervention

Lisboa-Gonçalves P.a · Libânio D.a,b · Marques-Antunes J.a · Dinis-Ribeiro M.a,b · Pimentel-Nunes P.a,b,c

Author affiliations

aCenter for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
bGastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
cDepartment of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal

Corresponding Author

Dr. Pedro Lisboa-Gonçalves

Faculty of Medicine, University of Porto

Al. Prof. Hernâni Monteiro

PT–4200-319 Porto (Portugal)

E-Mail pedro.silgon@gmail.com

Keywords: EsophagogastroduodenoscopyQuality auditSoftware registrationPerformance measure

Related Articles for ""
GE Port J Gastroenterol 2019;26:24–32
https://doi.org/10.1159/000487145

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Abstract

Background and Aim: In contrast to colonoscopy, there are few studies regarding upper gastrointestinal (UGI) endoscopy reporting its quality and ways of improving it. Quality audits are recommended, but their influence on the abovementioned quality is not well studied. Our aim was to evaluate the quality of UGI endoscopy reports and assess the effect of a simple audit intervention on UGI endoscopy reporting quality. Methods: This was a prospective study in a tertiary referral center, including the evaluation of 1,000 consecutive reports of UGI endoscopies before an audit intervention and 250 after. The reports were analyzed according to performance measures defined by three experienced gastroenterologists. Results: Before the intervention, 51.8% of the incomplete endoscopies did not present any justification for its incompleteness and 88.1% of lesions were correctly described. Overall, 64.1% of the reports were considered as being of high quality. After the audit intervention, follow-up recommendation (53.4 vs. 80.8%, p = 0.001), correct lesion description (88.1 vs. 95.8%, p = 0.001), and correct segment description (92.2 vs. 96.4%, p = 0.020) improved significantly. The rate of unjustified incomplete endoscopies decreased significantly (51.8 vs. 28.9%, p = 0.010). The high-quality endoscopy rate improved 13.9% after the intervention (p < 0.001). Both specialists and residents improved with the audit intervention with a similar percentage of improvement in the high-quality endoscopy rate (13.9 vs. 13.4%). Conclusions: A simple audit intervention is a good way to improve the quality of reporting of UGI endoscopy, independently of degree and experience. Some of the performance measure accomplishments may depend on the software used by the endoscopy centers and it should be a priority to optimize it.

© 2018 Sociedade Portuguesa de Gastrenterologia Published by S. Karger AG, Basel

Qualidade dos Relatórios na Endoscopia Digestiva Alta: Efeito de uma Intervenção com Auditoria

Palavras Chave

Endoscopia digestiva alta · Auditoria de qualidade · Software de registo · Parâmetros de qualidade ·

Resumo

Introdução: Em contraste com a colonoscopia, há poucos estudos relativos à qualidade dos relatórios da endoscopia digestiva alta (EDA) e métodos para a sua melhoria. Auditorias de qualidade são recomendadas, mas a sua influência na qualidade da EDA não está suficientemente estudada. O objetivo foi avaliar a qualidade dos relatórios de EDA, bem como do efeito de uma intervenção com auditoria. Métodos: Estudo prospetivo realizado num centro terciário de referência. O estudo incluiu a análise de 1,000 relatórios de EDA consecutivas realizadas antes de uma intervenção e de 250 após. Os relatórios foram ana­lisados de acordo com parâmetros de qualidade definidos por três gastrenterologistas com experiência. Resultados: Antes da intervenção, 51.8% das endoscopias incompletas não continham qualquer justificação para o facto e 88.1% das lesões foram corretamente descritas. No total, 64.1% dos relatórios foram considerados de alta qualidade. Após a intervenção, a recomendação de follow-up (53.4% vs. 80.8%, p = 0.001), descrição correta das lesões (88.1% vs. 95.8%, p = 0.001) e descrição correta de todos os segmentos (92.2% vs. 96.4%, p = 0.020) aumentaram significativamente. A percentagem de endoscopias incompletas não justificadas diminuiu significativamente (51.8% vs. 28.9%, p = 0.010). A percentagem de EDA de alta qualidade aumentou 13.9% após a intervenção (p c; 0.001). Tanto especialistas como internos melhoraram com a intervenção, verificando-se um aumento similar na percentagem de EDA de alta qualidade (13.9% vs. 13.4%). Conclusões: Uma intervenção baseada numa auditoria é uma boa forma de melhorar a qualidade da documentação de EDA independentemente do grau ou experiência. O cumprimento de parâmetros de qualidade pode depender do software utilizado e como tal o seu melhoramento deve ser uma prioridade.



Related Articles:

References

  1. Rembacken B, Hassan C, Riemann JF, et al: Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy. Endoscopy 2012; 44: 957–968.
    External Resources
  2. Rex DK, Schoenfeld PS, Cohen J, et al: Quality indicators for colonoscopy. Am J Gastroenterol 2015; 110: 72–90.
    External Resources
  3. Gavin DR, Valori RM, Anderson JT, et al: The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK. Gut 2013; 62: 242–249.
    External Resources
  4. Lieberman DA, Faigel DO, Logan J, et al: Assessment of quality of colonoscopy reports: Results from a multi-center consortium. Gastrointest Endosc 2009; 69: 645–653.
    External Resources
  5. Park WG, Shaheen NJ, Cohen J, et al: Quality indicators for EGD. Am J Gastroenterol 2015; 110: 60–71.
    External Resources
  6. Bisschops R, Areia M, Coron E, et al: Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2016; 48: 843–864.
    External Resources
  7. Pimenta-Melo AR, Monteiro-Soares M, Libânio D, et al: Missing rate for gastric cancer during upper gastrointestinal endoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2016; 28: 1041–1049.
    External Resources
  8. Bressler B, Paszat LF, Chen Z, et al: Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 2007; 132: 96–1024.
    External Resources
  9. Rutter MD, Rees CJ: Quality in gastrointestinal endoscopy. Endoscopy 2014; 46: 526–528.
    External Resources
  10. Córdova H, Sánchez-Montes C, Delgado-Guillena PG, et al: Quality indicators for esophagogastroduodenoscopy: a comparative study of outcomes after an improvement programme in a tertiary hospital. Gastroenterol Hepatol 2017; 40: 587–594.
    External Resources
  11. Gurudu SR, Ramirez FC: Quality metrics in endoscopy. Gastroenterol Hepatol 2013; 9: 228–233.
    External Resources
  12. Beaulieu D, Barkun AN, Tinmouth J, et al: Endoscopy reporting standards. Can J Gastroenterol 2013; 27: 286–292.
    External Resources
  13. Hadlock SD, Liu N, Gould M, et al: The quality of colonoscopy reporting in usual practice: are endoscopists reporting key data ele ments? Can J Gastroenterol Hepatol 2016; 2016: 1929361.
    External Resources
  14. Rex DK, Boland CR, Dominitz JA, et al: Colorectal Cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2017; 11: 1016–1030.
    External Resources
  15. Bretthauer M, Aabakken L, Dekker E, et al: Requirements and standards facilitating quality improvement for reporting systems in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2016; 48: 291–294.
    External Resources
  16. Taveira F, Areia M, Elvas L, et al: Quality in colonoscopy: beyond the adenoma detection rate fever. GE Port J Gastroenterol 2017; 24: 211–218.
    External Resources

Article / Publication Details

First-Page Preview
Abstract of Original Article

Received: October 12, 2017
Accepted: January 22, 2018
Published online: April 03, 2018
Issue release date: January - February

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 3

ISSN: 2341-4545 (Print)
eISSN: 2387-1954 (Online)

For additional information: https://www.karger.com/PJG

References

  1. Rembacken B, Hassan C, Riemann JF, et al: Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy. Endoscopy 2012; 44: 957–968.
    External Resources
  2. Rex DK, Schoenfeld PS, Cohen J, et al: Quality indicators for colonoscopy. Am J Gastroenterol 2015; 110: 72–90.
    External Resources
  3. Gavin DR, Valori RM, Anderson JT, et al: The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK. Gut 2013; 62: 242–249.
    External Resources
  4. Lieberman DA, Faigel DO, Logan J, et al: Assessment of quality of colonoscopy reports: Results from a multi-center consortium. Gastrointest Endosc 2009; 69: 645–653.
    External Resources
  5. Park WG, Shaheen NJ, Cohen J, et al: Quality indicators for EGD. Am J Gastroenterol 2015; 110: 60–71.
    External Resources
  6. Bisschops R, Areia M, Coron E, et al: Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2016; 48: 843–864.
    External Resources
  7. Pimenta-Melo AR, Monteiro-Soares M, Libânio D, et al: Missing rate for gastric cancer during upper gastrointestinal endoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2016; 28: 1041–1049.
    External Resources
  8. Bressler B, Paszat LF, Chen Z, et al: Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 2007; 132: 96–1024.
    External Resources
  9. Rutter MD, Rees CJ: Quality in gastrointestinal endoscopy. Endoscopy 2014; 46: 526–528.
    External Resources
  10. Córdova H, Sánchez-Montes C, Delgado-Guillena PG, et al: Quality indicators for esophagogastroduodenoscopy: a comparative study of outcomes after an improvement programme in a tertiary hospital. Gastroenterol Hepatol 2017; 40: 587–594.
    External Resources
  11. Gurudu SR, Ramirez FC: Quality metrics in endoscopy. Gastroenterol Hepatol 2013; 9: 228–233.
    External Resources
  12. Beaulieu D, Barkun AN, Tinmouth J, et al: Endoscopy reporting standards. Can J Gastroenterol 2013; 27: 286–292.
    External Resources
  13. Hadlock SD, Liu N, Gould M, et al: The quality of colonoscopy reporting in usual practice: are endoscopists reporting key data ele ments? Can J Gastroenterol Hepatol 2016; 2016: 1929361.
    External Resources
  14. Rex DK, Boland CR, Dominitz JA, et al: Colorectal Cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2017; 11: 1016–1030.
    External Resources
  15. Bretthauer M, Aabakken L, Dekker E, et al: Requirements and standards facilitating quality improvement for reporting systems in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2016; 48: 291–294.
    External Resources
  16. Taveira F, Areia M, Elvas L, et al: Quality in colonoscopy: beyond the adenoma detection rate fever. GE Port J Gastroenterol 2017; 24: 211–218.
    External Resources
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This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
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