Updated Global Rating Scale standards for 2021

Background: Intubation failure (IF) occurs when an endoscopist is unable to progress via the oropharynx into the upper oesophagus. Aim: To assess incidence and aetiology of IF and predictors of structural pharyngeal abnormalities in patients with IF.Methods: All gastroscopies (n=26,130) performed in our centre, between August 2010 and August 2016 were retrospectively reviewed. Barium radiology and repeat gastroscopy findings were evaluated for structural causes of IF. Patients were categorised into ‘failure to tolerate’ and ‘failure to progress’ based on endoscopy reports.Results: The incidence of IF was 0.95%. Rates of IF varied with endoscopist specialty (p=0.021), but not with patient age, sex or sedation dose. Among cases of IF, structural pharyngeal abnormalities were detected on barium radiology in 28.9%, consisting of cricopharyngeal hypertrophy and/or Zenker’s diverticulum in 73.2%. ‘Failure to progress’ predicted pharyngeal pathology in 55.6%. Predictors of structural causes on barium radiology following IF included: age ≥65 (OR 4.0, 95% CI: 1.8-8.9, p<0.001); indication of dysphagia (OR 5.5, 95% CI: 2.5-11.8, p<0.001), and failure of endoscopic progression (OR 5.2, 95% CI: 2.3-12.0, p<0.001).Conclusion: Patients with IF should be investigated owing to the high risk of underlying pathology, particularly if associated with age ≥65, dysphagia, and failure of endoscopic progression. We propose that IF rates of <1% could be used as a quality indicator in gastroscopy. .Abbreviations: ASGE: Association for Gastrointestinal Endoscopy; CI: Confidence interval; CP: Cricopharyngeus; CPH: Cricopharyngeal hypertrophy; FESD: Flexible endoscopic septum division; GRS: Global rating scale; IF: Intubation failure; JAG: Joint Advisory Group for gastrointestinal endoscopy; NME: Non-medical endoscopist; OR: Odds ratio; SI: Successful intubation; ZD: Zenker’s diverticulum.

Download Full-text

Impact of the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) on endoscopy services in the UK and beyond

Frontline Gastroenterology ◽

10.1136/flgastro-2018-100969 ◽

2018 ◽

Vol 10 (2) ◽

pp. 93-106 ◽

Cited By ~ 27

Author(s):

Keith Siau ◽

John T Green ◽

Neil D Hawkes ◽

Raphael Broughton ◽

Mark Feeney ◽

...

Keyword(s):

Quality Assurance ◽

Gastrointestinal Endoscopy ◽

Rating Scale ◽

Population Based ◽

Global Rating Scale ◽

Advisory Group ◽

Global Rating ◽

Endoscopy Training ◽

The Uk ◽

The Impact

The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) was initially established in 1994 to standardise endoscopy training across specialties. Over the last two decades, the position of JAG has evolved to meet its current role of quality assuring all aspects of endoscopy in the UK to provide the highest quality, patient-centred care. Drivers such as changes to healthcare agenda, national audits, advances in research and technology and the advent of population-based cancer screening have underpinned this shift in priority. Over this period, JAG has spearheaded various quality assurance initiatives with support from national stakeholders. These have led to the achievement of notable milestones in endoscopy quality assurance, particularly in the three major areas of: (1) endoscopy training, (2) accreditation of endoscopy services (including the Global Rating Scale), and (3) accreditation of screening endoscopists. These developments have changed the landscape of UK practice, serving as a model to promote excellence in endoscopy. This review provides a summary of JAG initiatives and assesses the impact of JAG on training and endoscopy services within the UK and beyond.

Download Full-text

British society of gastroenterology Endoscopy Quality Improvement Programme (EQIP): overview and progress

Frontline Gastroenterology ◽

10.1136/flgastro-2018-101073 ◽

2019 ◽

Vol 10 (2) ◽

pp. 148-153 ◽

Cited By ~ 4

Author(s):

Colin J Rees ◽

Sara Koo ◽

John Anderson ◽

Mark McAlindon ◽

Andrew M Veitch ◽

...

Keyword(s):

Quality Improvement ◽

Significant Variation ◽

Rating Scale ◽

Training System ◽

Support Network ◽

British Society ◽

Global Rating Scale ◽

Advisory Group ◽

Global Rating ◽

Gi Endoscopy

High quality gastrointestinal (GI) endoscopy improves patient care. Raising standards in endoscopy improves diagnostic accuracy, management of pathology and ultimately improves outcomes. Historical identification of significant variation in colonoscopy quality led to the development of the Joint Advisory Group (JAG) on GI Endoscopy, the Global Rating Scale (GRS), JAG Endoscopy Training System (JETS) training and certification. These measures led to major improvements in UK endoscopy but significant variation in practice still exists. To improve quality further the British Society of Gastroenterology Endoscopy Quality Improvement (EQIP) has been established with the aim of raising quality and reducing variation in the quality of UK endoscopy. A multifaceted approach to quality improvement (QI) will be undertaken and is described in this manuscript. Upper GI EQIP will support adoption of standards alongside regional upskilling courses. Lower GI EQIP will focus on supporting endoscopists to achieve current standards alongside approaches to reducing postcolonoscopy colorectal cancer rates. Endoscopic retrograde cholangiopancreatography EQIP will adopt a regional approach of using local data to support network-based QI. Newer areas of endoscopy practice such as small bowel endoscopy and endoscopic ultrasound will focus on identifying key performance indicators as well as standardising training and accreditation pathways. EQIP will also support QI in management of GI bleeding as well as standardising the approach to new techniques and technologies. Where evidence is lacking, approaches to gather new evidence and support the translation into clinical practice will be supported.

Download Full-text

Endoscopy in 2017: a national survey of practice in the UK

Frontline Gastroenterology ◽

10.1136/flgastro-2018-100970 ◽

2018 ◽

Vol 10 (1) ◽

pp. 7-15 ◽

Cited By ~ 26

Author(s):

Lavanya Shenbagaraj ◽

Siwan Thomas-Gibson ◽

John Stebbing ◽

Raphael Broughton ◽

Michael Dron ◽

...

Keyword(s):

Service Sector ◽

Rating Scale ◽

Waiting Times ◽

Global Rating Scale ◽

Advisory Group ◽

Global Rating ◽

Future Challenges ◽

Cancer Screening Programme ◽

Bowel Cancer Screening ◽

The Uk

IntroductionThe Joint Advisory Group on Gastrointestinal Endoscopy (JAG), hosted by the Royal College of Physicians, London, oversees the quality assurance of endoscopy services across the UK. Additional questions focusing on the pressures faced by endoscopy units to meet targets were added to the 2017 annual Global Rating Scale (GRS) return. This provides a unique insight into endoscopy services across all nations of the UK involving the acute and non-acute Nation Health Service sector as well as the independent sector.MethodsAll 508 services who are registered with JAG were asked to complete every field of the survey online in order to submit their completed April 2017 GRS return.ResultsA number of services reported difficulty in meeting national waiting time targets with a national average of only 55% of units meeting urgent cancer wait targets. Many services were insourcing or outsourcing patients to external providers to improve waiting times. Services are striving hard to increase capacity by backfilling lists and working weekends. Data collection was done in most units to reflect productivity but not to look at demand and capacity. Some of the units did not have an agreed capacity plan. The Did Not Attend rates for patients in the bowel cancer screening programme were much lower compared with standard lists.ConclusionThis review highlights the increased pressure endoscopy services are under and the ‘just about coping’ situation. This is the first published overview of different aspects of UK-wide endoscopy services and the future challenges.

Download Full-text

Otoskills training during covid-19 pandemic: a before-after study

BMC Medical Education ◽

10.1186/s12909-021-02706-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maxime Fieux ◽

Antoine Gavoille ◽

Fabien Subtil ◽

Sophie Bartier ◽

Stéphane Tringali

Keyword(s):

Surgical Training ◽

Rating Scale ◽

Surgical Simulation ◽

Global Rating Scale ◽

Middle Ear Surgery ◽

Global Rating ◽

Training Requirements ◽

Significant Difference ◽

Before And After ◽

Total Performance

Abstract Background The ongoing COVID-19 pandemic has disrupted the surgical training of residents. There is a real concern that trainees will not be able to meet their training requirements. Low-fidelity surgical simulation appears to be an alternative for surgical training. The educational benefits of repeating ossiculoplasty simulations under a microscope have never been evaluated. With this study we aimed to evaluate the differences in performance scores and on a global rating scale before and after training on an ossiculoplasty simulator. Methods In this quasi-experimental, prospective, single-centre, before-after study with blinded rater evaluation, residents performed five microscopic ossiculoplasty tasks with a difficulty gradient (sliding beads onto rods, the insertion of a partial prosthesis, the insertion of a total prosthesis, and the insertion of a stapedotomy piston under microscopic or endoscopic surgery) before and after training on the same simulator. Performance scores were defined for each task, and total performance scores (score/min) were calculated. All data were collected prospectively. Results Six out of seven intermediate residents and 8/9 novices strongly agreed that the simulator was an effective training device and should be included in the ENT residency program. The mean effect of training was a significant increase in the total performance score (+ 0.52 points/min, [95 % CI, 0.40–0.64], p < 0.001), without a significant difference between novice and intermediate residents. Conclusions This preliminary study shows that techniques for middle-ear surgery can be acquired using a simulator, avoiding any risk for patients, even under lockdown measures.

Download Full-text

The ASSET Global Rating Scale is a Valid and Reliable Adjunct Measure of Performance on a Virtual Reality Simulator for Hip Arthroscopy.

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.01.046 ◽

2021 ◽

Author(s):

Meghan E. Bishop ◽

Gabriella E. Ode ◽

Daniel Hurwit ◽

Stephan Zmugg ◽

Ryan Rauck ◽

...

Keyword(s):

Virtual Reality ◽

Hip Arthroscopy ◽

Rating Scale ◽

Global Rating Scale ◽

Global Rating ◽

Virtual Reality Simulator ◽

Measure Of Performance

Download Full-text

Objective structured assessment of technical skill in temporal bone dissection: validation of a novel tool

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001201 ◽

2021 ◽

pp. 1-11

Author(s):

M Stavrakas ◽

G Menexes ◽

S Triaridis ◽

P Bamidis ◽

J Constantinidis ◽

...

Keyword(s):

Temporal Bone ◽

Rating Scale ◽

Assessment Tool ◽

Three Dimensional ◽

Technical Skills ◽

Technical Skill ◽

Global Rating Scale ◽

Global Rating ◽

Validity And Reliability ◽

Cortical Mastoidectomy

Abstract Objective This study developed an assessment tool that was based on the objective structured assessment for technical skills principles, to be used for evaluation of surgical skills in cortical mastoidectomy. The objective structured assessment of technical skill is a well-established tool for evaluation of surgical ability. This study also aimed to identify the best material and printing method to make a three-dimensional printed temporal bone model. Methods Twenty-four otolaryngologists in training were asked to perform a cortical mastoidectomy on a three-dimensional printed temporal bone (selective laser sintering resin). They were scored according to the objective structured assessment of technical skill in temporal bone dissection tool developed in this study and an already validated global rating scale. Results Two external assessors scored the candidates, and it was concluded that the objective structured assessment of technical skill in temporal bone dissection tool demonstrated some main aspects of validity and reliability that can be used in training and performance evaluation of technical skills in mastoid surgery. Conclusion Apart from validating the new tool for temporal bone dissection training, the study showed that evolving three-dimensional printing technologies is of high value in simulation training with several advantages over traditional teaching methods.

Download Full-text