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Quality improvement of pediatric colonoscopy by application of bundle and centralization: A single-center review
Shu-Chao Weng1, Hung-Chang Lee1, Chun-Yan Yeung2
1Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan.
Insights
Implementing a pediatric colonoscopy bundle improved procedure quality, significantly increasing terminal ileum intubation and biopsy rates. This enhanced approach led to more stable bowel preparation and procedure times, benefiting young patients.
Area of Science:
- Pediatric Gastroenterology
- Endoscopy Quality Improvement
- Medical Procedure Optimization
Background:
- Assessing pediatric colonoscopy quality changes after implementing a bundled approach for bowel preparation and general anesthesia.
- Utilizing terminal ileum (TI) intubation rate as the primary indicator for procedural centralization and quality assessment.
Purpose of the Study:
- To evaluate the impact of a bundled intervention on pediatric colonoscopy quality.
- To determine if the intervention improved bowel preparation, diagnostic yield, and procedural efficiency.
Main Methods:
- Retrospective review of elective pediatric colonoscopies (patients <18 years) before (July 2015-June 2020) and after (August 2020-July 2021) bundle implementation.
- Analysis of demographic data, indications, bowel preparation quality, procedures performed, and intubation/procedure times.
- Statistical analysis using P value < 0.05 to determine significance.
Main Results:
- The terminal ileum intubation rate significantly increased from 42.2% to 75.0% (P=0.004).
- Biopsy rates also significantly improved, rising from 45.0% to 75.9% (P=0.01).
- Reduced variability in bowel preparation scores and procedure times indicated enhanced quality and stability post-intervention.
Conclusions:
- The bundled approach, incorporating improved bowel preparation and general anesthesia, significantly enhanced pediatric colonoscopy quality.
- Higher terminal ileum intubation and biopsy rates serve as key indicators of this quality improvement.
- The intervention facilitated procedural centralization and standardization in pediatric colonoscopy.
Background:
To assess the quality change of our single-center pediatric colonoscopy after applying bundle for bowel preparation and general anesthesia and centralize the procedure using terminal ileum (TI) intubation rate as the main indicator.
Methods:
All elective colonoscopies performed for patients younger than 18 years old in MacKay Memorial Hospital from July 2015 through June 2020 (assigned to group 1, before bundle) and from August 2020 through July 2021 (assigned to group 2, after bundle) were retrospectively reviewed for demographic characteristics, indications, bowel preparation agent and cleansing level, diagnostic and therapeutic procedures, maximum intestinal level reached, and cecal intubation and total procedure time. Statistical analysis was done using P value < 0.05 considered to be significant.
Results:
Analysis included 45 and 32 colonoscopies in group 1 and 2, respectively. Bloody stool was the most frequent indication in both groups. Both TI intubation rate (42.2 % vs. 75.0 %, P = 0.004) and biopsy rate (45.0 % vs. 75.9 %, P = 0.01) increased significantly from group 1 to group 2. The narrower standard deviation of bowel preparation score (1.93 vs. 1.15) and total procedure time (37.71 vs. 22.29) in group 2 indicated a more stable quality, although the mean showed no difference. There was no statistical difference in age, gender, body weight, cecal intubation rate, or cecal intubation time.
Conclusion:
A higher TI intubation rate and biopsy rate indicated an improved quality of pediatric colonoscopy after applying bundle including bowel preparation and general anesthesia, with additional centralization.
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