Improving Quality and Safety in the Endoscopy Unit (On-Demand) | October 2024-09_Case Studies_Defining and Measuring Quality in Endoscopy

09_Case Studies_Defining and Measuring Quality in Endoscopy

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The document outlines three cases that deal with evaluating and improving quality metrics in endoscopy practices.<br /><br />**Case 1** addresses a disparity in adenoma detection rate (ADR) among physicians. While the group average ADR is 42%, one highly productive physician has a much lower ADR of 26%. This physician also has a shorter average withdrawal time of 6 minutes compared to 8-10 minutes by others. Although the physician meets the current benchmarks, the lower ADR and faster withdrawal time could suggest a balance between speed and thoroughness might need adjusting. It's important to discuss optimizing both withdrawal time and detection thoroughness with this physician to improve the ADR without compromising productivity.<br /><br />**In Case 2**, a 60-year-old male was scheduled for an endoscopic ultrasound (EUS) to diagnose choledocholithiasis. The procedure confirmed the condition, and an ERCP slot is available immediately. However, the patient has only consented for EUS. The appropriate action is to respect the consent obtained and either delay the ERCP until additional consent is secured or discuss the urgency and obtain consent if the patient understands and agrees to proceed.<br /><br />**Case 3** involves differences in colonoscopy preparation quality between a hospital endoscopy unit and an affiliated ambulatory surgery center (ASC). The hospital endoscopy unit has a lower Boston Bowel Prep Score (BBPS) average of 6.2 and a higher colonoscopy repeat rate of 8.7%, compared to the ASC's 8.1 BBPS and 2.4% repeat rate. To address this, the hospital unit should review preparation protocols, consider implementing successful strategies from the ASC, and provide targeted training or resources to improve preparation quality and reduce repeat procedures.

Keywords

endoscopy

adenoma detection rate

withdrawal time

choledocholithiasis

consent

endoscopic ultrasound

ERCP

colonoscopy preparation

Boston Bowel Prep Score

quality metrics