Endoscopist feedback and report cards
Awareness of quality metrics among individuals and endoscopy practices is crucial to ensuring adequate performance. Several studies have shown improvement with feedback and monitoring of endoscopists.25,26 Some strategies to improve colonoscopy technique and efficiency include having recorded or observed procedures, computer software that measures image resolution/velocity, and scorecards with quality measures. A representation of the scorecards used in our practice is shown in Table 4. Feedback measures both make endoscopists aware of how their performance compares with recommended goals for colonoscopy and help track their improvement. We recommend such feedback should be provided quarterly for most providers and more frequently for providers not meeting benchmarks.
Conclusion
Given we rely on colonoscopy to identify and clear the colon of potential malignancy, it is imperative that we provide high-value exams for our patients. The basis for a quality colonoscopy is complete intubation and careful inspection of the mucosa on withdrawal. Several quality measures are used as surrogates of a good exam such that endoscopists can assess themselves in relation to their peers. These metrics can help us in our goal of remaining mindful during each procedure we are completing and providing the best exam possible.
Dr. Shamsi is a third-year GI fellow. Dr. Malhotra is an assistant professor in the division of gastroenterology at the University of Minnesota, Minneapolis. Dr. Shaukat is a professor of medicine in the division of gastroenterology at the University of Minnesota, Minneapolis, and the GI Section Chief at the Minneapolis VA Medical Center.
References
1. Siegel R et al. CA Cancer J Clin. 2012 Jan-Feb;62(1):10-29.
2. Edwards BK et al. Cancer. 2010 Feb 1;116(3):544-73.
3. Hosokawa O et al. Endoscopy. 2003 Jun;35(6):506-10.
4. Morris EJ et al. Gut. 2015(Aug);64(2):1248-56.
5. Bressler B et al. Gastroenterology. 2004 Aug;127(2):452-6.
6. Rex DK et al. Am J Gastroenterol. 2017 July;12(7):1016-30.
7. Rex DK et al. Gastrointest Endosc. 2015 Jan;81(1):31-53.
8. Anderson J et al. Clin Transl Gastroenterol. 2015 Feb 26;6:e77.
9. Kaminski M et al. N Engl J Med. 2010 May 13;362(19):1795-803.
10. Corley DA et al. N Engl J Med. 2014 Apr 3;370(4):1298-306.
11. Hunt RH. Colonoscopy intubation techniques without fluoroscopy. In: Colonoscopy techniques clinical practice and color atlas. Edited by Hunt RH, Waye JD. London: Chapman and Hall; 1981. p. 109-46.
12. Waye JD. Colonoscopy intubation techniques without fluoroscopy. In: Colonoscopy techniques clinical practice and color atlas. Edited by Hunt RH, Waye JD. London: Chapman and Hall; 1981. p. 147-78.
13. Williams CB et al. In: Colonoscopy principles & techniques. Edited by Raskin J, Juergen NH. New York: Igaku-Shoin Medical Publishers; 1995. p. 121-42.
14. Baillie J. Colonoscopy. In: Gastrointestinal endoscopy basic principles and practice. Oxford (UK): Butterworth-Heinemann; 1992. p. 63-92.
15. Rex DK. Gastrointest Endosc. 2000 Jan;51(1):33-6.
16. Shaukat A et al. Gastroenterol. 2015;149(4):952-7.
17. Barclay R et al. N Engl J Med. 2006 Dec 14;355(24):2533-41.
18. Simmons DT et al. Gastrointest Endosc. 2007;65(5):AB94.
19. Johnson DA et al. Gastrointest Endosc. 2014;80(4):543-62.
20. Calderwood A et al. Gastrointest Endosc. 2010 Oct;72(4):686-92.
21. Chokshi R et al. Gastrointest Endosc. 2012 Jun;75(6):1197-203.
22. Lebwohl B et al. Gastrointest Endosc. 2011 Jun;73(6):1207-14.
23. Menees SB et al. Gastrointest Endosc. 2013 Sep;78(3): 510-6.
24. Clark B et al. Am J Gastroenterol. 2014 Nov;109(11):1714-23.
25. Nielson A et al. BMJ Open Gastro. 2017 Jun. doi: 10.1136/bmjgast-2017-000142.
26. Gurudu S et al. J Gastroenterol Hepatol. 2018 Mar;33(3):645-9.
