Consensus Guidelines on Safety and
Quality Indicators in Endoscopy

November 13, 2012 4:00 am Views: 253
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The Canadian Association of Gastroenterology (CAG) was one of the first national specialty societies in Canada to define wait time benchmarks, monitor wait times and evaluate human resources, with an aim to improve access to timely, high-quality digestive healthcare for Canadians.

Human resource constraints and limited capacity in the face of increasing demands have highlighted the need for safe, high-quality, patient-centred health care delivery. Endoscopy is central to the effective management of many digestive problems; however, despite increased procedural volumes, with 1.6 million endoscopies performed annually in Canada, demand still exceeds supply. The CAG has, therefore, developed programs to promote quality in endoscopy such as the Quality Program – Endoscopy (QP-E) (Hospital News, October 2011) and more recently the CAG Consensus on Safety and Quality Indicators in Endoscopy, which was supported, in part, by the Canadian Partnership Against Cancer.

The Consensus identified processes and indicators relevant to the provision of high-quality endoscopy services, achieving consensus on broadly-applicable standards and key indicators that will support continuing quality improvement. A multidisciplinary group of experts (in endoscopy, gastroenterology, surgery, nursing, legal and ethical issues, patient perspectives and quality improvement in healthcare) from Canada, Europe and the US developed the 23 recommendations as listed below.

Ethics
  1. 1. For a patient to give a physician informed consent to perform an elective endoscopic procedure, the patient must be advised, in a timely fashion, of all relevant information about the procedure, its risks, benefits, and alternatives, if any, and be given an opportunity to ask questions that the physician must answer.
Facility standards and policies
  1. 2. Endoscopy facilities should meet or exceed defined operating standards, in all domains, consistent with accreditation by the appropriate national or regional standards.
  • 3. Endoscopic procedures are performed for an appropriate, clearly documented indication, consistent with current, evidence-based guidelines.
  • 4. Endoscopy facilities should have the technical and personnel resources required by national and/or regional standards to complete all planned procedures safely and effectively.
  • 5. Endoscopy facilities should implement and monitor the effect of pre-procedure policies that ensure best practice.
  • 6. Endoscopy facilities should implement and monitor the effect of intra-procedural policies that ensure best practice.
  • 7. The endoscopy facility should implement and monitor the effects of policies for the discharge of patients that ensure best practice.
  • 8. Endoscopy facilities should ensure that there is a policy in place to notify patients of the need and appropriate interval for follow-up.
  • 9. All patients, on discharge, are given written information regarding the procedural findings, plans for treatment and follow-up, worrisome symptoms to watch for, and steps to be taken.
Quality Assurance
  1. 10. Endoscopy facilities should maintain a comprehensive quality improvement program incorporating formal, regular, scheduled review of performance reports.
  • 11. Endoscopy facilities should appoint a review committee to monitor and report back to management on adherence to and implementation of quality standards.
  • 12. Endoscopy facilities should systematically and regularly review current indicators of quality for all endoscopic procedures and implement appropriate responses.
  • 13. Endoscopy facilities should systematically and regularly review current indicators of safety for all endoscopic procedures and implement appropriate responses.
Training, Education, Competency and Privileges
  1. 14. Endoscopy facilities should provide high-quality education programs or opportunities for all staff.
  • 15. All endoscopy facility personnel in-training should be supervised and their performance monitored regularly until they have achieved competency to perform specified routine and/or emergency procedures according to appropriate current standards.
  • 16. All endoscopy facility personnel engaged, directly or indirectly, in endoscopy service delivery should be trained and certified as having competency to perform specified routine and/or emergency procedures according to appropriate current standards.
  • 17. Endoscopists should regularly review their endoscopic practice and outcome data with the aim of continuous professional development.
  • 18. Endoscopists should be granted privileges to perform specified procedures based on a formal evaluation of their competence consistent with appropriate current standards.
  • 19. Endoscopists’ privileges should be subject to formal, regular, scheduled review to ensure that renewal is based on documented competence to perform specified procedures consistent with appropriate current standards.
Endoscopy Reporting Standards
  1. 20. Endoscopic procedures should be reported in a standardized electronic format, including mandatory reporting fields, to provide full documentation of all necessary clinical and quality measures.
  • 21. Endoscopy facilities should implement policies to monitor and ensure the timeliness and completeness of procedure reporting.
Patient Perceptions
  1. 22. Endoscopy facilities should ensure that the services they provide are patient-centred.
  • 23. Endoscopy facilities should systematically and at least annually solicit patient feedback, report the results to the service and to the institution’s quality committee, and implement effective measures to address patients’ concerns.

Gastrointestinal endoscopy is a complex diagnostic and therapeutic undertaking that demands a high level of skill and knowledge on the part of the operator. However, high-quality endoscopy requires more than a skilled operator. It must include the delivery of high quality endoscopy services in a cost-effective manner consistent with the broader needs of a health care system. A formal quality improvement framework that addresses all aspects of endoscopy service delivery from the patient’s initial contact with a health care provider (e.g. the identification of family history of colon cancer in an asymptomatic individual) through to documentation of long-term outcomes (e.g. freedom from colon cancer over decades) is also essential. Recognition of the patient as the focus of the endoscopy process provides a structure for integrating the efforts of the many diverse disciplines whose contribution is needed to ensure a high quality service.

For Patients

  • • These expert recommendations are available to assist any hospital/clinic and their staff in offering safe and high quality endoscopic procedures
  • • All relevant information about the procedure, its risks, benefits and any alternatives should be discussed with you and you should have the opportunity to have all your questions answered
  • • On discharge you should receive written information on findings, steps to be taken and worrisome symptoms to watch for
  • • You should be told if there is a need for follow up, and the appropriate interval for this
  • • Facilities following these recommendations may solicit your feedback in order to address any concerns

 

CAG welcomes endoscopy units to become involved in CAG’s quality programs. For more information please visit http://www.cag-acg.org 


Article By:

David Armstrong

David Armstrong, MD is the Canadian Association of Gastroenterology Quality Practice Lead.

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