[Quality indicators in colonoscopy].

BACKGROUND

Extensive use of colonoscopy has highlighted the need to assess the quality of the procedures in order to reduce costs and increase efficiency.

AIMS

(1) To assess quality indicators of colonoscopies performed by specialist physicians in Rambam HeaLth Care Campus; (2) To improve the quality of colonoscopies using the data collected.

METHODS

Data was collected retrospectively from reports of 700 colonoscopies performed by 7 gastroenterology specialists in Rambam Health Care Campus. The data collected was compared to relevant Literature benchmarks for accepted quality indicators.

RESULTS

A total of 95.3% of procedures had appropriate indications. Good or excellent bowel preparation was documented for 57.4% of procedures with a range for individual physicians from 18.2%-84%. Completion rate was 92.4% (range 89.9%-97%). Overall polyp detection rate was 29.1% (range 17%-45%). Polyp detection rate in screening colonoscopies was 13.2% for women and 26.1% for men. Biopsies were taken in 90.3% of colonoscopies performed for inflammatory bowel disease (IBD) follow-up and in 75% of colonoscopies performed in patients with chronic diarrhea. Follow-up recommendations were noted in 82.6% of procedures with any indication for follow-up (range 70%-92.5%).

CONCLUSIONS

Colonoscopies are performed in Rambam Health Care Campus in an effective manner with regard to completion rate and polyp detection. High rates of intermediate or poor bowel preparation, suboptimal rates of taking biopsies and making follow-up recommendations were noted. Significant variations among participating physicians were noted. Conclusions led to operative changes in practice, including improving computerized reports, standardizing assessments of preparation and initiating a continuous quality improvement program.