About My Health Careers Internship MedBlogs Contact us
Medindia LOGIN REGISTER
Advertisement

Quality of Colonoscopy Reporting Assessed in New Study

by Kathy Jones on January 26, 2012 at 8:57 PM
Font : A-A+

 Quality of Colonoscopy Reporting Assessed in New Study

The quality of colonoscopy reporting in daily clinical practice has been assessed by researchers in the Netherlands. They also evaluated the quality of colonoscopy performance.

They found that colonoscopy reporting varied significantly in clinical practice. Colonoscopy performance met the suggested standards, however, considerable variability between endoscopy departments was found. Researchers concluded that the results of the study underline the importance of the implementation of quality indicators and guidelines, and that by continuous monitoring of quality parameters, the quality of both colonoscopy reporting and colonoscopy performance can easily be improved. The study appears in the January issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

Advertisement

Quality assurance in endoscopy has become an important topic in recent decades. The implementation of colorectal cancer screening has driven a significant portion of these quality initiatives in colonoscopy. Suggested quality indicators for colonoscopy include, among others, cecal intubation rate, adenoma detection rate (ADR), and withdrawal time. Without complete and accurate reporting of colonoscopy parameters, continuous quality assurance is meaningless because deficits in service and quality improvements over time cannot be identified. By determining underlying reasons for quality deficits, specific training and education projects can be implemented to achieve the maximum benefit from colonoscopic procedures.

"Studies of quality indicators focus to a great extent on single quality indicators and often show the results of quality assurance in nondaily clinical practice, such as screening programs and study settings, where endoscopists were aware of the quality audit or were obliged to complete automated colonoscopy reporting systems. Less is known about the compliance with colonoscopy reporting and performance in daily clinical practice," said study lead author Vincent de Jonge, MSc, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. "Our study examined both reporting and performance in daily practice. We found that reporting varied significantly in clinical practice and that while performance met the suggested standards, there was considerable variability between endoscopy departments."
Advertisement

Methods

This study took place in the daily clinical practice of 12 endoscopy departments in the Netherlands (six teaching hospitals and six general hospitals). At the time of the study, there was no comprehensive quality assurance program either nationwide or at any of the endoscopy departments individually, although over the past 15 years, the Dutch Society of Gastroenterologists has put in place and maintained a quality audit system for endoscopy units. This system requires that endoscopy units and their staff undergo a thorough quality audit every five years according to a fixed format by trained external auditors from the Dutch Society. The audit focuses on, for example, organizational aspects of the units, case mix, number of endoscopy procedures performed, waiting lists, and complication registration, but not on specific performance indicators of individual endoscopists such as those investigated in this study (i.e., cecal intubation rate and ADR). The staff of each participating endoscopy department was informed about the study protocol and parameters of interest, and ethical approval was obtained from each institutional review board. During the study period, colonoscopies and colonoscopy reporting were performed according to local protocols.

A total of 4,800 colonoscopy reports were included covering scheduled colonoscopies on 4,738 patients. Reports were reviewed by hand. Quality of reporting was assessed by using the American Society for Gastrointestinal Endoscopy criteria for colonoscopy reporting. Quality of colonoscopy performance was evaluated by using cecal intubation rate and ADR.

Results

The 4,800 colonoscopies were performed by 116 endoscopists: 70 percent by gastroenterologists, 16 percent by gastroenterology fellows, 10 percent by internists, 3 percent by nurse-endoscopists, and 1 percent by surgeons. The mean age of the patients was 59 years old and 47 percent were male. Reports contained information on indication, sedation practice, and extent of the procedure in more than 90 percent. Only 62 percent of the reports mentioned the quality of bowel preparation (range between departments was 7 to 100 percent). Photographic documentation of the cecal landmarks was present in 71 percent (range was 22 to 97 percent). The adjusted cecal intubation rate was 92 percent (range was 84 to 97 percent) and the ADR was 24 percent (range was 13 to 32 percent).

The researchers concluded that overall, the quality of colonoscopy reporting was high, although significant variability existed. This variance suggests that, with a relatively small amount of effort, the quality of reporting can be improved significantly. This may be achieved with the widespread introduction of computerized image storage and endoscopy reporting, and also has the potential to be cost-saving compared with handwritten or dictated reports. The overall quality of colonoscopy performance reached international standards, although remarkable variability between endoscopy departments was found. By continuous quality monitoring and disclosure of results, the overall quality of performance can be further improved. This study emphasizes that national guidelines for both colonoscopy performance and reporting parameters are needed to set common targets for the quality of colonoscopy, thereby improving uniformity in daily clinical practice of both colonoscopy reporting and colonoscopy performance.

In an accompanying editorial, David A. Johnson, MD, FACG, FASGE, Department of Internal Medicine Gastroenterology Division, Eastern VA Medical School, Norfolk, Virginia, states, "The results of this study highlight several important points. First, there is clearly room for significant improvement, both for reporting and performance of colonoscopy. Second, despite the use of the quality metrics, there was not consistent use nor was there any improvement even when the endoscopists knew that they were being evaluated. This suggests that the process perhaps needs to be better standardized via an electronic report with required fields. What the study does not address is whether this information was to be used in feedback to the individual endoscopists as part of a quality improvement program, which clearly should be the intent of comparative metrics."
Source: Eurekalert
Advertisement

Advertisement
News A-Z
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Advertisement
News Category
What's New on Medindia
Cochlear Implants may Consequently Drive Hearing Loss
E-cigarettes Use Linked to Erectile Dysfunction
Memory Loss - Can it be Recovered?
View all

Medindia Newsletters Subscribe to our Free Newsletters!
Terms & Conditions and Privacy Policy.

More News on:
Ulcerative Colitis Crohns Disease Irritable Bowel Syndrome Diverticulosis and Diverticulitis Colorectal Cancer Screening Colorectal Cancer Screening with Flexible Sigmoidoscopy Colorectal Cancer Screening with Colonoscopy Digestive Tract Ulcers Symptom Evaluation 

Recommended Reading
Colon Polyps
A colon polyp is a fleshy growth on the inside of the colon, also called the large intestine. In ......
Colo-rectal cancer - Management
Treatment for Colorectal Cancers may involve surgery,chemotherapy, radiation therapy or biological ....
Colonoscopy Procedure - Animation
An animation of Colonoscopy that shows the appearance of large intestine or colon by using a thin .....
Colorectal Cancer Screening
Colorectal screening is done using tests to detect blood in stool, colonoscopy or sigmoidoscopy ordo...
Colorectal Cancer Screening with Colonoscopy
Colonoscopy is a widely used endoscopic procedure to screen individuals for colorectal cancer. It is...
Colorectal Cancer Screening with Flexible Sigmoidoscopy
Flexible sigmoidoscopy is an endoscopic procedure used to screen individuals for colorectal cancer s...
Crohns Disease
Crohn’s disease or regional enteritis is an inflammatory bowel disease that involves the small intes...
Digestive Tract Ulcers Symptom Evaluation
A break in the mucus membrane lining of the digestive tract results in ulcers....
Diverticulosis and Diverticulitis
Diverticulosis is characterized by sac-like outpouching in the intestinal wall. Inflammation of div...
Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) causes recurrent abdominal pain or discomfort and a fluctuating distu...
Ulcerative Colitis
Ulcerative colitis is characterized by bouts of diarrhea, bleeding per rectum and pain, which remits...

Disclaimer - All information and content on this site are for information and educational purposes only. The information should not be used for either diagnosis or treatment or both for any health related problem or disease. Always seek the advice of a qualified physician for medical diagnosis and treatment. Full Disclaimer

© All Rights Reserved 1997 - 2021

This site uses cookies to deliver our services. By using our site, you acknowledge that you have read and understand our Cookie Policy, Privacy Policy, and our Terms of Use