Achieving high quality colonoscopy: using graphical representation to measure performance and reset standards.

Area of Science:

• Gastroenterology
• Endoscopy
• Quality Improvement in Healthcare

Background:

• Colonoscopy quality is assessed by caecal intubation rate (CIR) and adenoma detection rate (ADR).
• National benchmarks are set at ≥90% for CIR and ≥10% for ADR.
• Variability exists, making comparisons challenging.

Purpose of the Study:

• To evaluate colonoscopy performance across endoscopy units in Northeast England.
• To assess adherence to national quality standards for CIR and ADR.
• To identify potential areas for improvement in colonoscopy practice.

Main Methods:

• Data collected over 3 months from 12 endoscopy units.
• Included colonoscopies performed by screening colonoscopists for CIR.
• Utilized funnel plots to visualize CIR and ADR variability with confidence limits.

Main Results:

• Achieved a CIR of 92.5% and an ADR of 15.9%.
• All units met the CIR standard; 99.2% of colonoscopists exceeded the lower limit.
• All units met the ADR standard; 76.7% of colonoscopists exceeded 10% ADR.
• Median sedation doses and complication rates (bleeding 0.10%, perforation 0.02%) were recorded.

Conclusions:

• Colonoscopies in Northeast England are performed safely and to a high standard.
• Funnel plots effectively highlight performance variability.
• Analysis suggests a revised national ADR standard of 15% is appropriate.