Naylor G, Gatta L, Butler A, Duffet S, Wilcox M, Axon A T, O'Mahony S
Centre for Digestive Diseases, Leeds General Infirmary, Leeds, United Kingdom.
Endoscopy. 2003 Aug;35(8):701-7. doi: 10.1055/s-2003-41508.
Both patients and government demand proof of quality of care and value for money. Our unit ist in a large teaching hospital, performing over 6000 procedures per year. We have designed and implemented a Quality Assurance (QA) program, the basis of which we believe could be a model for endoscopy QA.
A QA team was formed and a literature search undertaken. An initial 3 month audit was then performed into indications for, and complications of, all procedures. The results of this initial audit led us to concentrate on colonoscopy and ERCP. The specific items of data collected were based on the "Core Quality Indicators" developed by the American Society for Gastrointestinal Endoscopy (ASGE). We also analysed data relating to endoscope disinfection, equipment failure and carried out a patient satisfaction survey. The data were presented at 3-monthly QA meeting, and appropriate action taken.
We performed a detailed audit of ERCP (217 procedures) and colonoscopy (904 procedures). Patients risk was stratified using the American Society of Anaesthesiology (ASA) classification. Using these data we established our technical success and complication rates for colonoscopy and ERCP. Audit of equipment revealed that on average an endoscope was away for repair 9 % of the time. Contamination of endoscopes was frequent with glutaraldehyde disinfection; the rate of contamination fell dramatically when we changed our disinfection method.
A QA program can be implemented in busy endoscopy units. There are significant problems, however, in ensuring that such a program is effective: these include inadequate funding/staffing, lack of suitable information technology and lack of clear guidelines for dealing with poor performance.
患者和政府都要求提供医疗质量和性价比的证据。我们所在的科室位于一家大型教学医院，每年进行超过6000例手术。我们设计并实施了一项质量保证（QA）计划，我们认为其基础可以成为内镜质量保证的一个典范。
成立了一个质量保证团队并进行了文献检索。然后对所有手术的适应症和并发症进行了为期3个月的初步审核。初步审核的结果使我们将重点放在结肠镜检查和内镜逆行胰胆管造影术（ERCP）上。收集的具体数据项目基于美国胃肠内镜学会（ASGE）制定的“核心质量指标”。我们还分析了与内镜消毒、设备故障相关的数据，并开展了患者满意度调查。数据在每季度的质量保证会议上公布，并采取了适当的行动。
我们对ERCP（217例手术）和结肠镜检查（904例手术）进行了详细审核。使用美国麻醉医师协会（ASA）分类对患者风险进行分层。利用这些数据，我们确定了结肠镜检查和ERCP的技术成功率和并发症发生率。设备审核显示，平均而言，一台内镜有9%的时间在维修。戊二醛消毒时内镜污染频繁；当我们改变消毒方法时，污染率大幅下降。
质量保证计划可以在繁忙的内镜科室实施。然而，要确保这样一个计划有效存在重大问题：这些问题包括资金/人员不足、缺乏合适的信息技术以及缺乏处理表现不佳情况的明确指南。
