Development of a national root cause analysis system for post-endoscopy upper gastrointestinal cancer

Area of Science:

• Gastroenterology
• Oncology
• Health Services Research

Background:

• Post-endoscopy upper gastrointestinal cancer (PEUGIC) signifies a delay in diagnosis.
• PEUGIC occurs when an initial endoscopy misses a diagnosis, with cancer confirmed 3-36 months later.
• Identifying PEUGIC is crucial for improving endoscopy performance and patient outcomes.

Purpose of the Study:

• To describe a national system for identifying PEUGIC.
• To implement a root cause analysis (RCA) process for identified PEUGIC cases.
• To analyze the largest cohort of PEUGIC to date and inform quality improvement.

Main Methods:

• A retrospective national study using English National Health Service (NHS) data.
• Identification of PEUGIC through linkage of Hospital Episode Statistics and cancer registry data.
• Development of an online platform for endoscopy providers to conduct RCA on their PEUGIC cases.

Main Results:

• Successfully identified 3907 PEUGIC cases between January 2017 and October 2023.
• Completed RCA for 2666 PEUGIC cases, forming the world's largest cohort.
• 17% of identified cases were ineligible upon local review, highlighting the need for clear criteria.

Conclusions:

• A transferable methodology for identifying PEUGIC and conducting RCA within a national healthcare system was established.
• The RCA process facilitates learning from diagnostic delays to enhance local endoscopy quality.
• This system provides a framework for improving diagnostic accuracy and patient care in upper gastrointestinal cancers.