Fratté Serge, Daucourt Valentin, Fatisse Abdelaziz, Winkfield Betsy
Service de gastroentérologie, Centre hospitalier de Belfort-Montbéliard, F-90000 Belfort, France.
Presse Med. 2008 Sep;37(9):1212-9. doi: 10.1016/j.lpm.2007.09.026. Epub 2008 Mar 7.
The aim of this study was to evaluate the quality of the medical care associated with the colonoscopies performed in our gastrointestinal endoscopy unit. This 6-month prospective, comparative study used process and result indicators. Its long-term objective was to improve the quality of care and to select a few pertinent quality indicators for continual monitoring.
An audit was conducted of all total colonoscopies performed at our general hospital from November 2005 through May 2006. It assessed the principal published process and result indicators for the medical aspects of the procedure as well as patient satisfaction (indication, procedure itself, results, complications, satisfaction). These indicators were also compared between endoscopists.
During the 6-month study period, 202 total colonoscopies were performed. Waiting time for the procedure, appropriateness of the indication, proportion of colonoscopies completed, proportion of neoplastic lesions found, adequacy of bowel preparation, frequency of complications, and patient satisfaction were similar to and even above the standard values. However, patient information and the completeness of the legal documents were insufficient. Although the mean values were satisfactory, detailed individual analysis showed statistically significant differences between endoscopists. For example, the proportion of withdrawal times exceeding 6 minutes was 16.3%, 25.0% and 86.4% according to endoscopist. The mean number of polyps each removed per procedure was respectively 1, 2, and 3 (p<0.05). An improvement plan was implemented in view of these results, and appropriate simple indicators were selected for prospective monitoring.
Despite the overall results, which essentially complied with standard guidelines, our prospective and comparative audit of colonoscopies pointed out significant variations between individual endoscopists and helped us to define improvement actions and indicators.
本研究旨在评估我们胃肠内镜科进行的结肠镜检查相关医疗护理的质量。这项为期6个月的前瞻性比较研究使用了过程指标和结果指标。其长期目标是提高护理质量并选择一些相关的质量指标进行持续监测。
对2005年11月至2006年5月在我们综合医院进行的所有全结肠镜检查进行了审核。评估了该操作医疗方面的主要已发表过程指标和结果指标以及患者满意度（适应证、操作本身、结果、并发症、满意度）。还在内镜医师之间对这些指标进行了比较。
在为期6个月的研究期间，共进行了202例全结肠镜检查。操作等待时间、适应证的恰当性、结肠镜检查完成比例、发现的肿瘤性病变比例、肠道准备充分性、并发症发生率和患者满意度与标准值相似甚至高于标准值。然而，患者信息和法律文件的完整性不足。尽管平均值令人满意，但详细的个体分析显示内镜医师之间存在统计学上的显著差异。例如，根据内镜医师不同，退镜时间超过6分钟的比例分别为16.3%、25.0%和86.4%。每次操作切除的息肉平均数量分别为1、2和3（p<0.05）。鉴于这些结果实施了改进计划，并选择了适当的简单指标进行前瞻性监测。
尽管总体结果基本符合标准指南，但我们对结肠镜检查的前瞻性比较审核指出了个体内镜医师之间的显著差异，并帮助我们确定了改进措施和指标。
