Hard to Swallow Results.

Area of Science:

• Gastroenterology
• Medical Quality Improvement

Background:

• The American Neurogastroenterology and Motility Society (ANMS) established quality measures (QMs) for esophageal manometry (EM).
• Effective implementation of these QMs is crucial for accurate diagnosis and patient care.

Purpose of the Study:

• To assess and improve adherence to ANMS QMs for EM performance and interpretation.
• To evaluate the impact of a quality improvement initiative based on Chicago Classification 3.0 (CC) Guidelines in a community hospital setting.

Main Methods:

• A quality improvement study was conducted, involving pre- and post-intervention assessments of EM studies.
• Independent reviewers reinterpreted studies for compliance with ANMS QMs, focusing on procedural aspects and data interpretation.
• Interventions included developing a pre-procedural form, nursing education, and providing feedback to gastroenterologists.

Main Results:

• Significant improvements were observed in nursing staff's procedural compliance for swallows (e.g., 76% vs. 12% for 30s swallows).
• Physician data interpretation showed mixed results, with 50% incorrect diagnoses and 72% missing interpretation items based on CC.
• Fragmented peristalsis was the most common missed diagnosis (30%), and 24% of inappropriate surgery referrals occurred.

Conclusions:

• Community gastroenterologists without specialized motility training demonstrated poor data interpretation of EM studies.
• Adequate nursing performance in EM procedures was achieved, but physician interpretation remains a challenge.
• The findings underscore the necessity for a national certification process for formal HRM education and competency.