Lachter Jesse, Bluen Benjamin, Waxman Irving, Bellan Wafaa
Jesse Lachter, Departments of Gastroenterology, Head of EUS Service, Rambam Healthcare Campus, Haifa 30196, Israel.
World J Gastrointest Endosc. 2013 Nov 16;5(11):574-80. doi: 10.4253/wjge.v5.i11.574.
To perform a quality control (QC) review of endoscopic ultrasound (EUS) with emphasis on current consensus established quality indicators.
A national quality control study of EUS was performed with expanded international comparison. Ten different healthcare institutions in Israel participated in coordination with University of Chicago Medical Center. Each Israeli center provided ten patient reports, compared with twenty reports from University of Chicago Medical Center. Quality indicator forms were prepared with sections to be completed before, during, and after EUS. Physician compliance to all listed indicators was evaluated. Quality indicators were evaluated prior to, during, and after performing EUS.
One hundred different EUS procedural reports were analyzed. The mean patient age was 59 years old. Indications for referral were mostly for pancreatic or biliary reasons. QC showed several strongly reported areas, including indications for EUS (97%), anesthesia given (94%), periprocedural pancreatic evaluation (87%), and an overall summary of the EUS examination (82%). Intermediately reported areas included patients' pertinent past medical history (71.7%), evaluation of the biliary tree (63%), and providing medical guidance about potential procedural adverse events, including pancreatitis and bleeding (52%). Half of the reports (50%) did not include a systemic organ evaluation. Other areas, including systematic reporting of screened organs (36%), description of fine needle aspiration (15%), tumor description via tumor-node-metastasis (5%), and listing of adverse events (0%) were largely lacking from procedural documentation.
Documenting specific EUS quality indicators including listing post-procedural recommendations may improve the quality and efficiency of future EUS examinations and subsequent patient follow-up.
对内窥镜超声检查（EUS）进行质量控制（QC）审查，重点关注当前已确立的质量指标共识。
开展了一项EUS全国质量控制研究，并进行了扩展的国际比较。以色列的十家不同医疗机构与芝加哥大学医学中心合作参与。每个以色列中心提供十份患者报告，并与芝加哥大学医学中心的二十份报告进行比较。编制了质量指标表格，其中包含在EUS检查前、检查期间和检查后需填写的部分。评估医生对所有列出指标的依从性。在进行EUS检查之前、期间和之后对质量指标进行评估。
分析了一百份不同的EUS检查程序报告。患者的平均年龄为59岁。转诊指征主要是胰腺或胆道方面的原因。质量控制显示了几个报告较多的方面，包括EUS检查的指征（97%）(、)给予的麻醉（94%）(、)围手术期胰腺评估（87%）以及EUS检查的总体总结（82%）。报告程度中等的方面包括患者相关的既往病史（71.7%）(、)胆道树评估（63%）以及提供关于潜在手术不良事件（包括胰腺炎和出血）的医疗指导（52%）。一半的报告（50%）未包括系统器官评估。其他方面，包括筛查器官的系统报告（36%）(、)细针穿刺描述（15%）(、)通过肿瘤-淋巴结-转移对肿瘤的描述（5%）以及不良事件列表（0%）在检查程序文档中大多缺失。
记录特定的EUS质量指标，包括列出术后建议，可能会提高未来EUS检查的质量和效率以及后续患者随访的质量和效率。
