The ASGE Quality Course: Improving Quality and Safety in the Endoscopy Unit (Virtual) | November 2025-Leveraging the IOM Domains of Quality in Decision-making

Pdf Summary

This presentation by Dr. Sonali Palchaudhuri from Massachusetts General Hospital focuses on leveraging the Institute of Medicine (IOM) Domains of Quality to enhance decision-making and quality improvement in endoscopy units. The IOM quality framework, established in 2001's "Crossing the Quality Chasm," defines six interdependent domains: safe, effective, efficient, patient-centered, timely, and equitable care, with some adding a seventh—sustainable care—to consider environmental impact.

Key points include detailed definitions and clinical examples of each domain applied to endoscopy practices:

- <strong>Safety:</strong> Avoiding harm via reducing complications (e.g., post-colonoscopy perforations)
- <strong>Effectiveness:</strong> Providing evidence-based services, such as guideline-concordant colonoscopy screening
- <strong>Efficiency:</strong> Minimizing waste of time and resources by optimizing workflow and case scheduling
- <strong>Patient-centeredness:</strong> Respecting patient preferences (e.g., sex of endoscopist, language needs)
- <strong>Timeliness:</strong> Reducing delays in care delivery and procedure scheduling
- <strong>Equity:</strong> Ensuring quality care regardless of socioeconomic or demographic factors
- <strong>Sustainability:</strong> Incorporating environmentally conscious practices like reusing supplies

The talk illustrates evaluating practical scenarios, such as BMI-based site restrictions for endoscopy and use of simethicone in procedure prep, by balancing positive and negative impacts across all quality domains. It emphasizes careful consideration of trade-offs in clinical policy changes.

Quality measurement and improvement rely on the Donabedian Model—assessing structure (e.g., technology, staff), process (e.g., procedural techniques), and outcomes (e.g., adenoma detection rates, complication rates). Establishing a multidisciplinary quality improvement team with dedicated leadership, data analysts, IT support, and staff engagement is vital for ongoing performance monitoring and system improvements.

The session concludes by underlining the importance of holistic, domain-conscious approaches to define and measure quality metrics within endoscopy units. Leveraging these frameworks supports safer, more effective, efficient, and equitable care aligned with value-based health care goals.

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Sonali Palchaudhuri, MD, MHCI

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Keywords

Institute of Medicine Domains of Quality

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efficiency in medical procedures

equity in healthcare delivery

sustainability in medical practices

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IOM Quality Domains

Donabedian Framework

Quality Improvement Program

Safety

Effectiveness