2020
Flávio Pereira, Richard Azevedo, Marisa Linhares, Diana Ramos, João Pinto, Ana Caldeira, José Tristan, Eduardo Pereira, Rui Sousa, António Banhudo
Hospital Amato Lusitano, Castelo Branco, Portugal
Endoscopie – 2020-06-16 – CO –
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Introduction: In the last decade, societies of gastrointestinal endoscopy identified quality in colonoscopy as a priority on their agenda, given the significant discrepancy between gastroenterologists/endoscopy units concerning rate of cecal intubation, rate of adenoma detection or quality of bowel preparation. Thence, a set of quality indicators was identified in order to measure the performance of the gastroenterologist or the endoscopy unit, aiming the implementation of approaches to optimize performance. An audit study to evaluate these indicators, followed by the disclosure of the results (feedback), may improve individual and collective performance.
Aim and Methods: We aimed to assess the impact of an internal audit and feedback on compliance to quality indicators in colonoscopy. We conducted an intervention study on a group of specialists and residents of Gastroenterology. Random 350 screening or diagnostic colonoscopies were included from patients aged ≥50 years between September/2017 and August/2018. Quality indicators were assessed according to ESGE recommendations (2017). In November/2018, the results of the audit were disclosed to the group. Then, another sample of 350 colonoscopies performed between January-September/2019 was similarly selected and analysed.
Results: 700 patients were included (55% male; mean age 67±10 years). 86% of colonoscopies performed without sedation. After the audit and feedback intervention, significant improvements were found in the cecal intubation rate (90,9% vs 94,9%, p<0,05), photodocumentation of the appendiceal orifice (65,4% vs 80,1% , p<0,001), reporting of quality of bowel preparation (87,1% vs 99,1%, p<0,001) and use of a quantitative validated scale to assess bowel cleansing (66,9% vs 92,9%, p<0,001). There was also an increase in the rate of detection of polyps (41,8% vs 47,2%) and adenomas (33,3% vs 36,4%) after the intervention, but with no statistical significance. Conclusions: An internal audit and feedback intervention improved the compliance of gastroenterologists to quality indicators in colonoscopy. If seen as a dynamic process of ongoing improvement, this type of study can be useful to create awareness for the need of implementation of metodologies to optimize individual and collective performance.