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Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopists and
Catharine M Walsh1, Jenifer R Lightdale2, Ian H Leibowitz3
1Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
Insights
High-quality pediatric endoscopy relies on skilled providers. This study establishes international standards and indicators for assessing and improving the quality of care in pediatric endoscopy procedures worldwide.
Area of Science:
- Pediatric Gastroenterology
- Medical Quality Improvement
- Endoscopic Procedures
Background:
- High-quality pediatric endoscopy is crucial for optimal patient outcomes.
- Assessing and monitoring individual pediatric endoscopists is essential for ensuring consistent quality of care.
- International consensus on quality expectations is needed for pediatric endoscopic procedures.
Purpose of the Study:
- To provide guidance for defining and measuring the quality of endoscopic care in children.
- To establish international standards and indicators for assessing pediatric endoscopists.
- To inform continuous quality improvement initiatives for pediatric endoscopy providers.
Main Methods:
- An international working group (Pediatric Endoscopy Quality Improvement Network - PEnQuIN) was formed with support from NASPGHAN and ESPGHAN.
- The Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument methodology was used.
- Consensus was achieved through an online Delphi process and a final in-person conference, with recommendations rated using the GRADE approach.
Main Results:
- Consensus was reached on 6 standards for all pediatric endoscopy providers and 2 standards for trainees.
- Seven indicators were identified to assess high-quality pediatric endoscopists and inform quality improvement.
- Minimum targets for high-quality pediatric ileocolonoscopy were set: cecal intubation rate (≥90%) and terminal ileal intubation rate (≥85%).
Conclusions:
- Individual providers performing or training in pediatric endoscopy should adopt these international standards and indicators.
- These standards and indicators facilitate the assessment of individual provider competence.
- Engagement with these PEnQuIN-developed metrics can enhance the quality of pediatric endoscopic procedures globally.
Introduction:
High-quality pediatric endoscopy requires reliable performance of procedures by competent individual providers who consistently uphold all standards determined to assure optimal patient outcomes. Establishing consensus expectations for ongoing monitoring and assessment of individual pediatric endoscopists is a method for confirming the highest possible quality of care for such procedures worldwide. We aim to provide guidance to define and measure quality of endoscopic care for children.
Methods:
With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of endoscopists. Consensus was sought via an iterative online Delphi process and finalized at an in-person conference. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach.
Results:
The PEnQuIN working group achieved consensus on 6 standards that all providers who perform pediatric endoscopy should uphold and 2 standards for pediatric endoscopists in training, with 7 corresponding indicators that can be used to identify high-quality endoscopists. Additionally, these can inform continuous quality improvement at the provider level. Minimum targets for defining high-quality pediatric ileocolonoscopy were set for 2 key indicators: cecal intubation rate (≥90%) and terminal ileal intubation rate (≥85%).
Discussion:
It is recommended that all individual providers performing or training to perform pediatric endoscopy initiate and engage with these international endoscopist-related standards and indicators developed by PEnQuIN.
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