Quality in endoscopic service
Over the last decade, the Canadian Association of Gastroenterology (CAG) has undertaken several important initiatives to help improve access to timely, high quality digestive health care for Canadians. CAG was one of the first national specialty societies inCanada, and the only one in the area of digestive health care, to define wait time benchmarks, monitor actual wait times and examine manpower. These published data confirm that many wait time targets are not being met and, furthermore, that wait times for digestive health care were excessive and that they remain so.
As a member of the Wait Time Alliance, the CAG continues its efforts to address wait times and improve access to digestive health care for all Canadians. However, manpower constraints and limited capacity in the face of increasing demands emphasize the need to ensure safe, high quality, patient-centred health care delivery and appropriate utilization of our limited resources. Importantly, the National Health Service (NHS) inEnglandhas reported that a patient-centred approach to quality improvement in endoscopy delivered, not only improved quality, but also, improved access.
The CAG is, therefore, leading a national program, in collaboration with the Canadian Partnership Against Cancer (CPAC), to drive quality assessment and quality improvement in digestive endoscopy and gastroenterology, with the primary goal of supporting the delivery of high quality digestive health services to all Canadians.
Endoscopy is crucial for the effective management of diverse digestive problems, including gastroesophageal reflux disease (GERD), peptic ulcer disease, celiac disease and inflammatory bowel disease, as well as the detection and prevention of gastrointestinal cancers. With 1.6 million endoscopic procedures performed annually inCanada(Canadian Institutes of Health Information, 2008-2009), it is essential that patients receive the highest quality care. This can only be achieved if care is provided by well‐trained health care professionals working in an appropriate environment with proper equipment to deliver care that is responsive to patients’ needs.
Enter the ‘Quality Program – Endoscopy (QP-E)’
The Quality Program – Endoscopy (QP-E) provides a means of assessing and, ultimately, improving the delivery of patient-centred endoscopic services in Canada. Begun in 2008, as a pilot program, the QP-E has expanded to hospitals and clinics across Canada. The two main elements of the QP-E – the Global Rating Scale (GRS) and the Colonoscopy Practice Audit – are described below.
Global Rating Scale
Developed in theU.K.and adapted for the Canadian environment, the GRS is an online tool that enables endoscopy unit personnel to assess how well they provide the various elements of a patient-centred service. The scale is constructed in a way to a) help services determine the quality of the service they provide and b) guide services through a series of quality improvement interventions. At each participating site, representatives from the nursing, medical and administrative teams meet twice yearly to perform a comprehensive evaluation of their service, based on a series of statements under the 12 listed areas.
|Quality of the Procedure||Customer Care|
The basic principles underlying the GRS are that it is patient-centred and that it requires regular monitoring of quality and safety indicators with a commitment to sustained, iterative quality improvement. The GRS promotes quality improvement in all aspects of the endoscopy services, and therefore offers benefits from many perspectives including an overall assessment, as well as the perspective of the endoscopist, the endoscopy nurse, the endoscopy unit manager, and the patient.
Colonoscopy Practice Audit
Practice audits allow physicians to review patient records related to a specific area of their practice. In the colonoscopy practice audit of the QP-E, endoscopists complete a short audit of consecutive outpatients undergoing colonoscopy over a two-week period. Questions related to anonymous patient data and the colonoscopy are answered in the endoscopy suite at the point of care on smartphone, BlackBerry, iPhone or the Web. Via a secure and unique login, endoscopists can immediately review their data online and compare them with national results recorded by their peers. Data on wait times for consultation, procedure and total wait times, along with quality indicator measures such as insertion and withdrawal times, completeness of the procedure and quality of the bowel preparation, serve to inform physicians regarding their colonoscopic practice and to identify personal learning and professional development opportunities.
Participants may claim section three credits (3 credits/hour) in accordance with the Royal College of Physicians and Surgeons of Canada (RCPSC) Maintenance of Certification (MOC) program guidelines, providing endoscopists with an additional incentive for skill maintenance and improvement. The CAG was honoured to receive a 2011 RCPSC Accredited Continuing Professional Development Provider Innovation Award for the colonoscopy practice audit.
Baseline GRS and practice audit results allow unit staff to identify and implement targeted interventions to improve the timeliness, quality and safety of the endoscopy service provided. After several months, the GRS assessment and practice audit are repeated with the aim of demonstrating improvements in the targeted areas, and to allow staff to look for other aspects of service delivery to be enhanced.
Hospitals and clinics participating in the QP-E and meeting set criteria are presented with CAG’s Quality Endoscopy Recognition Award, in acknowledgement of their commitment to continuous quality improvement. To date, 20 endoscopy facilities across Canadahave received this award for the year 2010-2011. For more information on the QP-E please visit the CAG Web site www.cag-acg.org or email QP-E@cag-acg.org.