quality indicators for established endoscopists

1. QUALITY INDICATORS FOR ESTABLISHED ENDOSCOPISTS Jonathan Green University Hospital of North Staffs

2. “We all go to work each day to do a good job”

3. QUALITY No universal definition of this elusive concept No single objective quantifiable measurable variable that accurately reflects quality So, how do we assess this in respect of GI Endoscopy? We need a range of measures that we will call “Quality Indicators in GI Endoscopy” The matrix (not the sum) of these individual measures will, taken together, reflect some important aspects of service (and individual) quality

4. WHY DO ESTABLISHED ENDOSCOPISTS NEED QUALITY INDICATORS? Guidance – how to develop/modify the service and individual skills Benchmarking – assessment of the service provided against peers Protection – from critics – from every corner - and from inadequately resourced competition Accreditation – as part of re-licensing and re-validation – both for unit and for endoscopist All above apply at both Unit and Individual level

5. QUALITY INDICATORS IN ENDOSCOPY Specific -to the procedure/endoscopist Measurable -some form of quantification Appropriate -important measure Relevant -non-random, objective Timely -current, contemporaneous

6. QUALITY INDICATORS IN ENDOSCOPY ASGE suggests classification into categories of:- STRUCTURE PROCESS OUTCOME Note:- This is not just about auditable outcomes – although they are an important part of this

7. WHAT MIGHT QUALITY INDICATORS IN ENDOSCOPY LOOK LIKE? Work in progress -BSG Endoscopy Committee

8. Quality Indicators in an ERCP service 1)Structure A minimum of 2 ERCP-trained endoscopists per centre An agreed minimum workload (procedure type/volume) per endoscopist An Endoscopy Unit caseload of at least 150 procedures per year A nominated radiologist to lead Imaging Department quality issues

9. Quality Indicators in an ERCP service 2) Process Evidence of consultant involvement in every decision to perform (c/f request) ERCP e.g. by case note audit Pre-ERCP pre-assessment of in-patients by appropriately trained staff member(s) Less than 5% of ERCP’s intended as purely diagnostic examinations Formal recording of adverse events e.g. significant complications and mortality

10. Quality Indicators in an ERCP service 3) Outcome Completion of the intended therapeutic procedure in at least 80% of cases Clinically symptomatic pancreatitis in less than 5% Post- sphincterotomy significant bleeding <2% Sedation reversal agents used in <1% Evidence of patient acceptability/satisfaction e.g. from audits, complaints (formal and informal)

11. QUALITY INDICATORS IN ENDOSCOPY BSG Endoscopy Committee / National Endoscopy Lead are further refining ASGE QI’s Intention to use QI’s to underpin the Quality and Safety sections of the GRS This means refining the ASGE concept

12. QUALITY INDICATORS IN ENDOSCOPY

13. QUALITY INDICATORS IN ENDOSCOPY Early stages of devising quality indicators Many unanswered questions as yet e.g. Which indicators to use? And why? Evidence-based? Are numbers valid? Who selects the indicators? How do we collect / obtain the data? Who analyses / reports / adjudicates the data? What effect will this process have on activity and throughput?

14. SUMMARY You will hear a lot more about QI’s in future Established endoscopists should largely welcome them as a development by the profession for the profession Process is designed to help and assist endoscopists to do a good / better job by providing feedback on elements of the service which together make up the elusive characteristic QUALITY