Colonoscopy: practice variation among 69 hospital-based endoscopists

Area of Science:

• Gastroenterology
• Medical Quality Improvement

Background:

• Growing interest in colonoscopy quality from medical professionals, payers, and patients.
• The American Society for Gastrointestinal Endoscopy (ASGE) recommends "report cards" for endoscopists to track practice quality.
• Key elements include indications, findings, duration, technical endpoints, complications, and patient satisfaction.

Purpose of the Study:

• To analyze colonoscopy performance data from individual endoscopists.
• To assess adherence to recommended quality metrics in a large cohort.
• To identify areas for potential quality improvement in endoscopic procedures.

Main Methods:

• Utilized the GI-Trac endoscopy reporting database, collecting prospective data from seven North American hospital centers.
• Aggregated and analyzed data from 17,868 colonoscopies performed by 69 endoscopists.
• Focused on key performance indicators such as procedure duration, cecal intubation rates, and normal findings.

Main Results:

• Twelve percent of endoscopists reported over 20% of procedures as completely normal.
• 27% of endoscopists exceeded an average procedure time of 40 minutes (excluding trainees).
• Cecal intubation rates varied, with 55% achieving >90% and 9% achieving <80%.

Conclusions:

• The data offer insights into individual endoscopist performance in colonoscopy, primarily within academic settings.
• Integrating comprehensive data elements into reporting databases is crucial for effective benchmarking.
• Future efforts should focus on utilizing such data for meaningful quality improvement initiatives in endoscopy.