Fraser Alan G, Gamble Greg D, Rose Toby R, Dunn John P
N Z Med J. 2013 Sep 13;126(1382):25-35.
The goals of colonoscopy are changing over time and it is important to regularly determine if endoscopists are achieving key performance indicators.
Data on key performance indicators were recorded independently by nursing staff for all colonoscopies performed during a 10-year period. The results were discussed at regular meetings and feedback given to endoscopists.
Audit data was recorded for 67,570 procedures. The key performance indicators (time to caecum, withdrawal time, adjusted caecal intubation rate and polyp detection rate) all improved over the audit period (p<0.0001 for trend). For each endoscopist the mean withdrawal time was highly variable ranging from 3.1 mins (95%CI 3.0; 3.1) to 11.2 mins (11.0; 11.3). For each endoscopist mean polyp detection rate varied from 29% (CI 26, 31%) to 69% (CI 68, 70%). There was a significant correlation between mean withdrawal time and mean polyp detection rate for each endoscopist (r=0.42; p=0.03). The polyp detection rate improved from 29% in 1999 to 49% in 2010. The proportion of procedures with more than 2 polyps increased from 22% in 2001 to 33% in 2010. There was a significant association of patient discomfort with time to caecum and also to level of consciousness, p<0.0001. There was a significant decrease in the proportion with significant discomfort over the audit period, p<0.0001.
Colonoscopy audit as a routine process with data collection by endoscopy nurses over several years may be able to improve key performance indicators by the process of regular feedback to endoscopists. Audit should be encouraged as a routine process rather than simply as a research tool for a limited period.
结肠镜检查的目标随时间而变化，定期确定内镜医师是否达到关键绩效指标很重要。
护理人员独立记录了10年期间所有结肠镜检查的关键绩效指标数据。定期会议上讨论结果并向内镜医师提供反馈。
记录了67570例检查的审核数据。关键绩效指标（到达盲肠时间、退镜时间、调整后的盲肠插管率和息肉检出率）在审核期间均有所改善（趋势p<0.0001）。对于每位内镜医师，平均退镜时间差异很大，范围从3.1分钟（95%CI 3.0；3.1）到11.2分钟（11.0；11.3）。对于每位内镜医师，平均息肉检出率从29%（CI 26，31%）到69%（CI 68，70%）不等。每位内镜医师的平均退镜时间与平均息肉检出率之间存在显著相关性（r=0.42；p=0.03）。息肉检出率从1999年的29%提高到2010年的49%。有2个以上息肉的检查比例从2001年的22%增加到2010年的33%。患者不适与到达盲肠时间以及意识水平显著相关，p<0.0001。在审核期间，有明显不适的比例显著下降，p<0.0001。
作为一项由内镜护士多年收集数据的常规流程，结肠镜检查审核通过定期向内镜医师反馈的过程，可能会改善关键绩效指标。应鼓励将审核作为常规流程，而不仅仅是在有限时期内作为研究工具。
