Improving Quality and Safety in the Endoscopy Unit (On-Demand)

ASGE ACG QI for ERCP 2015

Pdf Summary

The American Society for Gastrointestinal Endoscopy (ASGE) has released an update on quality indicators for Endoscopic Retrograde Cholangiopancreatography (ERCP), a complex and high-risk procedure. ERCP has shifted from being primarily diagnostic to therapeutic and is crucial in the non-surgical management of pancreaticobiliary disorders. Recognizing the need for high-quality performance in ERCP, the ASGE outlined a set of quality indicators for training and practice.<br /><br />Quality indicators are tools to measure health care performance against established benchmarks and are categorized into structural, process, and outcome measures. These indicators help assess health care environments, procedures, and medical outcomes. The update emphasizes indicators for ERCP across three stages: pre-procedure, intra-procedure, and post-procedure, focusing on process measures given the challenges in routinely measuring outcome indicators due to the need for extensive data and follow-up.<br /><br />The ASGE update from 2015 refines these indicators by integrating new data and identifying clinically relevant metrics validated through studies or expert consensus. Key indicators were prioritized for their broad clinical applications, evidence-based validation, and measurement feasibility. Performance targets were set using benchmarking data, and where unavailable, expert consensus was used to define goals.<br /><br />Pre-procedure indicators include proper documentation of appropriate indications, obtaining informed consent, and risk assessment. Intra-procedure indicators emphasize achieving deep duct cannulation and documenting fluoroscopy time. Post-procedure indicators focus on document preparation, adverse event tracking, and patient follow-up.<br /><br />The ASGE also recommends tracking high-priority indicators, such as the rate of deep cannulation and post-ERCP pancreatitis, to guide continuous quality improvement. This updated framework aims to enhance patient care, ensure procedural success, and minimize complications by providing a structured approach to measuring and improving the quality of ERCP procedures.

Keywords

ASGE

ERCP

quality indicators

pancreaticobiliary disorders

pre-procedure

intra-procedure

post-procedure

deep duct cannulation

benchmarking

patient follow-up