scholarly journals Endoscopy Reporting Standards

2013 ◽  
Vol 27 (5) ◽  
pp. 286-292 ◽  
Author(s):  
Daphnée Beaulieu ◽  
Alan N Barkun ◽  
Catherine Dubé ◽  
Jill Tinmouth ◽  
Pierre Hallé ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Bowel Preparation ◽  
Task Force ◽  
Patient Comfort ◽  
Pathology Report ◽  
Continuous Quality ◽  
Consensus Group ◽  
Canadian Association ◽  
Standardized Report ◽  
Examination Quality

OBJECTIVES: The Canadian Association of Gastroenterology (CAG) recently published consensus recommendations for safety and quality indicators in digestive endoscopy. The present article focuses specifically on the identification of key elements that should be found in all electronic endoscopy reports detailing recommendations adopted by the CAG consensus group.METHODS: A committee of nine individuals steered the CAG Safety and Quality Indicators in Endoscopy Consensus Group, which had a total membership of 35 voting individuals with knowledge on the subject relating to endoscopic services. A comprehensive literature search was performed with regard to the key elements that should be found in an electronic endoscopy report. A task force reviewed all published, full-text, adult and human studies in French or English.RESULTS: Components to be entered into the standardized report include identification of procedure, timing, procedural personnel, patient demographics and history, indication(s) for procedure, comorbidities, type of bowel preparation, consent for the procedure, pre-endoscopic administration of medications, type and dose of sedation used, extent and completeness of examination, quality of bowel preparation, relevant findings and pertinent negatives, adverse events and resulting interventions, patient comfort, diagnoses, endoscopic interventions performed, details of pathology specimens, details of follow-up arrangements, appended pathology report(s) and, when available, management recommendations. Summary information should be provided to the patient or family.CONCLUSION: Continuous quality improvement should be the responsibility of every endoscopist and endoscopy facility to ensure improved patient care. Appropriate documentation of endoscopic procedures is a critical component of such activities.

scholarly journals Indicators of Safety Compromise in Gastrointestinal Endoscopy

2012 ◽  
Vol 26 (2) ◽  
pp. 71-78 ◽  
Author(s):  
Mark R Borgaonkar ◽  
Lawrence Hookey ◽  
Roger Hollingworth ◽  
Ernst J Kuipers ◽  
Alan Forster ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Quality Indicators ◽  
Gastrointestinal Endoscopy ◽  
Metabolic Complications ◽  
Screening Programs ◽  
Consensus Group ◽  
Canadian Association ◽  
Improvement Programs ◽  
Quality Improvement Programs

The growth in the use of endoscopy to diagnose and treat many gastointestinal disorders, and its central role in cancer screening programs, has led to a significant increase in the number of procedures performed. This growth, however, has also led to many variations in, among others, the provision of services, the choice of sedative medications and the training of providers. The recognition of the significance of quality in endoscopy has prompted several countries, including Canada, to initiate efforts to adopt nationwide quality improvement programs. The Canadian Association of Gastroenterology formed a committee to review endoscopy and quality with the aim of stimulating improvement. This article focuses specifically on patient safety indicators that were developed at a consensus conference aimed at generating a broad range of recommendations for selected endoscopic procedures, which if adopted, could lead to significant changes in how endoscopy services are provided.INTRODUCTION: The importance of quality indicators has become increasingly recognized in gastrointestinal endoscopy. Patient safety requires the identification and monitoring of occurrences associated with harm or the potential for harm. The identification of relevant indicators of safety compromise is, therefore, a critical element that is key to the effective implementation of endoscopy quality improvement programs.OBJECTIVE: To identify key indicators of safety compromise in gastrointestinal endoscopy.METHODS: The Canadian Association of Gastroenterology Safety and Quality Indicators in Endoscopy Consensus Group was formed to address issues of quality in endoscopy. A subcommittee was formed to identify key safety indicators. A systematic literature review was undertaken, and articles pertinent to safety in endoscopy were identified and reviewed. All complications and measures used to document safety were recorded. From this, a preliminary list of 16 indicators was compiled and presented to the 35-person consensus group during a three-day meeting. A revised list of 20 items was subsequently put to the consensus group for vote for inclusion on the final list of safety indicators. Items were retained only if the consensus group highly agreed on their importance.RESULTS: A total of 19 indicators of safety compromise were retained and grouped into the three following categories: medication-related – the need for CPR, use of reversal agents, hypoxia, hypotension, hypertension, sedation doses in patients older than 70 years of age, allergic reactions and laryngospasm/bronchospasm; procedure-related early – perforation, immediate postpolypectomy bleeding, need for hospital admission or transfer to emergency department from the gastroenterology unit, instrument impaction, severe persistent abdominal pain requiring evaluation proven to not be perforation; and procedure-related delayed – death within 30 days of procedure, 14-day unplanned hospitalization, 14-day unplanned contact with a health provider, gastrointestinal bleeding within 14 days of procedure, infection or symptomatic metabolic complications.CONCLUSIONS: The 19 indicators of safety compromise in endoscopy, identified by a rigorous, evidence-based consensus process, provide clear outcomes to be recorded by all facilities as part of their continuing quality improvement programs.

scholarly journals Colorectal Cancer Surveillance after Index Colonoscopy: Guidance from the Canadian Association of Gastroenterology

2013 ◽  
Vol 27 (4) ◽  
pp. 224-228 ◽  
Author(s):  
Desmond Leddin ◽  
Robert Enns ◽  
Robert Hilsden ◽  
Carlo A Fallone ◽  
Linda Rabeneck ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Task Force ◽  
Cancer Surveillance ◽  
Screening Tests ◽  
Average Risk ◽  
Health Care Environment ◽  
Canadian Association ◽  
The Us ◽  
Colonoscopy Surveillance

BACKGROUND: Differences between American (United States [US]) and European guidelines for colonoscopy surveillance may create confusion for the practicing clinician. Under- or overutilization of surveillance colonoscopy can impact patient care.METHODS: The Canadian Association of Gastroenterology (CAG) convened a working group (CAG-WG) to review available guidelines and provide unified guidance to Canadian clinicians regarding appropriate follow-up for colorectal cancer (CRC) surveillance after index colonoscopy. A literature search was conducted for relevant data that postdated the published guidelines.RESULTS: The CAG-WG chose the 2012 US Multi-Society Task Force (MSTF) on Colorectal Cancer to serve as the basis for the Canadian position, primarily because the US approach was the simplest and comprehensively addressed the issue of serrated polyps. Aspects of other guidelines were incorporated where relevant. The CAG-WG recommendations differed from the US MSTF guidelines in three main areas: patients with negative index colonoscopy should be followed-up at 10 years using any of the appropriate screening tests, including colonos-copy, for average-risk individuals; among patients with >10 adenomas, a one-year interval for subsequent colonoscopy is recommended; and for long-term follow-up, patients with low-risk adenomas on both the index and first follow-up procedures can undergo second follow-up colonos-copy at an interval of five to 10 years.DISCUSSION: The CAG-WG adapted the US MSTF guidelines for colonoscopy surveillance to the Canadian health care environment with a few modifications. It is anticipated that the present article will provide unified guidance that will enhance physician acceptance and encourage appropriate utilization of recommended surveillance intervals.

M1021 Endoscopy Unit Quality Indicators for Colonoscopy: the Canadian Association of Gastroenterology (cag) Endoscopy Quality Initiative (EQI) Practice Audit Project

2009 ◽  
Vol 136 (5) ◽  
pp. A-333
Author(s):  
David Armstrong ◽  
Roger Hollingworth ◽  
Donald G. MacIntosh ◽  
Ying Chen ◽  
Ronald Bridges ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Endoscopy Unit ◽  
Canadian Association ◽  
Audit Project ◽  
Practice Audit

scholarly journals Quality Indicators of the Pre-Analytical Phase

2012 ◽  
Vol 31 (3) ◽  
pp. 174-183 ◽  
Author(s):  
Nada Majkić-Singh ◽  
Zorica Šumarac
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Quality Indicators ◽  
Task Force ◽  
Improve Patient Safety ◽  
Laboratory Data ◽  
Sample Collection ◽  
Laboratory Errors ◽  
Analytical Phase ◽  
Total Testing Process

Quality Indicators of the Pre-Analytical PhaseQuality indicatorsare tools that allow the quantification of quality in each of the segments of health care in comparison with selected criteria. They can be defined as an objective measure used to assess the critical health care segments such as, for instance, patient safety, effectiveness, impartiality, timeliness, efficiency, etc. In laboratory medicine it is possible to develop quality indicators or the measure of feasibility for any stage of the total testing process. The total process or cycle of investigation has traditionally been separated into three phases, the pre-analytical, analytical and post-analytical phase. Some authors also include a »pre-pre« and a »post-post« analytical phase, in a manner that allows to separate them from the activities of sample collection and transportation (pre-analytical phase) and reporting (post-analytical phase). In the year 2008 the IFCC formed within its Education and Management Division (EMD) a task force calledLaboratory Errors and Patient Safety (WG-LEPS)with the aim of promoting the investigation of errors in laboratory data, collecting data and developing a strategy to improve patient safety. This task force came up with the Model of Quality Indicators (MQI) for the total testing process (TTP) including the pre-, intra- and post-analytical phases of work. The pre-analytical phase includes a set of procedures that are difficult to define because they take place at different locations and at different times. Errors that occur at this stage often become obvious later in the analytical and post-analytical phases. For these reasons the identification of quality indicators is necessary in order to avoid potential errors in all the steps of the pre-analytical phase.

scholarly journals Medical oncology workload in Canada: infrastructure, supports, and delivery of clinical care

2018 ◽  
Vol 25 (3) ◽  
pp. 206 ◽  
Author(s):  
A. Fundytus ◽  
W.M. Hopman ◽  
N. Hammad ◽  
J.J. Biagi ◽  
R. Sullivan ◽  
...  
Keyword(s):  
Online Survey ◽  
Task Force ◽  
Clinical Care ◽  
Median Number ◽  
Models Of Care ◽  
Annual Number ◽  
Canadian Association ◽  
Level Of Activity ◽  
Medical Oncologists ◽  
Number Of Patients

Background In 2000, a Canadian task force recommended that medical oncologists (mos) meet a target of 160–175 new patient consultations per year. Here, we report the Canadian results of a global survey of mo workload compared with mo workload in other high-income countries (hics).Methods Using a snowball method, an online survey was distributed by national oncology societies to chemotherapy-prescribing physicians in 22 hics (World Bank criteria). The survey was distributed within Canada to all members of the Canadian Association of Medical Oncologists. Workload was measured as the annual number of new cancer patient consults per oncologist.Results The survey was completed by 782 oncologists from hics, including 58 from Canada. Median annual consults per mo were 175 in Canada compared with 125 in other hics. The proportions of mos having 100 or fewer consults or more than 300 consults per year were 3% (2/58) and 5% (3/58) in Canada compared with 31% (222/724) and 16% (116/724) in other hics (p < 0.001 and p = 0.023 respectively). The median number of patients seen in a full-day clinic was 15 in Canada and 25 in other hics (p = 0.220). Canadian mos reported spending a median of 55 minutes per new consultation; new consultations of 35 minutes were reported in other hics (p < 0.001). Median hours worked per week was 55 in Canada and 45 in other hics (p = 0.200).Conclusions Although the median annual clinical volume for Canadian mos aligns with recommended targets, half the respondents exceeded that level of activity. Health policymakers and educators have to consider mo workforce supply and alternative models of care in preparation for the anticipated surge in cancer incidence in the coming decade.

scholarly journals Comparison of the Boston Bowel Preparation Scale with an Auditable Application of the US Multi-Society Task Force Guidelines

2018 ◽  
Vol 2 (2) ◽  
pp. 57-62 ◽  
Author(s):  
Valérie Heron ◽  
Myriam Martel ◽  
Talat Bessissow ◽  
Yen-I Chen ◽  
Etienne Désilets ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Task Force ◽  
The Us

scholarly journals Point-of-Care, Peer-Comparator Colonoscopy Practice Audit: The Canadian Association of Gastroenterology Quality Program – Endoscopy

2011 ◽  
Vol 25 (1) ◽  
pp. 13-20 ◽  
Author(s):  
David Armstrong ◽  
Roger Hollingworth ◽  
Donald MacIntosh ◽  
Ying Chen ◽  
Sandra Daniels ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Point Of Care ◽  
Outcome Data ◽  
Care Practice ◽  
Colon Polyps ◽  
Cecal Intubation ◽  
Withdrawal Time ◽  
Canadian Association ◽  
The Mean ◽  
Practice Audit

BACKGROUND: Point-of-care practice audits allow documentation of procedural outcomes to support quality improvement in endoscopic practice.OBJECTIVE: To evaluate a colonoscopists’ practice audit tool that provides point-of-care data collection and peer-comparator feedback.METHODS: A prospective, observational colonoscopy practice audit was conducted in academic and community endoscopy units for unselected patients undergoing colonoscopy. Anonymized colonoscopist, patient and practice data were collected using touchscreen smart-phones with automated data upload for data analysis and review by participants. The main outcome measures were the following colonoscopy quality indicators: colonoscope insertion and withdrawal times, bowel preparation quality, sedation, immediate complications and polypectomy, and biopsy rates.RESULTS: Over a span of 16 months, 62 endoscopists reported on 1279 colonoscopy procedures. The mean cecal intubation rate was 94.9% (10th centile 84.2%). The mean withdrawal time was 8.8 min and, for nonpolypectomy colonoscopies, 41.9% of colonoscopists reported a mean withdrawal time of less than 6 min. Polypectomy was performed in 37% of colonoscopies. Independent predictors of polypectomy included the following: endoscopy unit type, patient age, interval since previous colonoscopy, bowel preparation quality, stable inflammatory bowel disease, previous colon polyps and withdrawal time. Withdrawal times of less than 6 min were associated with lower polyp removal rates (mean difference −11.3% [95% CI −2.8% to −19.9%]; P=0.01).DISCUSSION: Cecal intubation rates exceeded 90% and polypectomy rates exceeded 30%, but withdrawal times were frequently shorter than recommended. There are marked practice variations consistent with previous observations.CONCLUSION: Real-time, point-of-care practice audits with prompt, confidential access to outcome data provide a basis for targeted educational programs to improve quality in colonoscopy practice.

M1018 Quality Indicators for Colonoscopy in Canada: the Canadian Association of Gastroenterology (cag) Endoscopy Quality Initiative (EQI) Practice Audit Project

2009 ◽  
Vol 136 (5) ◽  
pp. A-332
Author(s):  
David Armstrong ◽  
Roger Hollingworth ◽  
Donald G. MacIntosh ◽  
Joanne Cabrera ◽  
Ying Chen ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Canadian Association ◽  
Audit Project ◽  
Practice Audit

scholarly journals Propofol Use for Sedation during Endoscopy in Adults: A Canadian Association of Gastroenterology Position Statement

2008 ◽  
Vol 22 (5) ◽  
pp. 457-459 ◽  
Author(s):  
Michael F Byrne ◽  
Naoki Chiba ◽  
Harminder Singh ◽  
Daniel C Sadowski ◽  
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Rapid Onset ◽  
Position Statement ◽  
Patient Comfort ◽  
Medical Evidence ◽  
Onset Of Action ◽  
Propofol Sedation ◽  
The Past ◽  
Canadian Association ◽  
Rapid Clearance

Over the past decade, multiple clinical reports have demonstrated that the use of propofol sedation for gastrointestinal endoscopy by gastroenterologists and trained endoscopy nurses is safe and effective in appropriately selected patients. Proposed benefits of propofol sedation include rapid onset of action, improved patient comfort and rapid clearance, as well as prompt recovery and discharge from the endoscopy unit. As a result of medical evidence, a number of international professional societies have endorsed the use of propofol in gastrointestinal endoscopy. In Canada, no formal guidelines currently exist. In the present article, the Clinical Affairs Committee of the Canadian Association of Gastroenterology presents a position statement, incorporating updated information on the use of propofol sedation for endoscopy in adult patients.

scholarly journals PWE-200 The impact of bowel preparation on other colonoscopy quality indicators: Abstract PWE-200 Table 1

Gut ◽  
2012 ◽  
Vol 61 (Suppl 2) ◽  
pp. A378.2-A378 ◽  
Author(s):  
S K Butt ◽  
H Defoe ◽  
K Besherdas
Keyword(s):  
Quality Indicators ◽  
Bowel Preparation ◽  
Colonoscopy Quality ◽  
The Impact
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