Department of Gastroenterology and Hepatology, Research Institute Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Flevo Hospital, Almere, The Netherlands.
Endoscopy. 2023 Sep;55(9):812-819. doi: 10.1055/a-2069-6588. Epub 2023 Apr 5.
High quality colonoscopy is fundamental to good patient outcomes. "Textbook outcome" has proven to be a feasible multidimensional measure for quality assurance between surgical centers. In this study, we sought to establish the "textbook process" (TP) as a new composite measure for the optimal colonoscopy process and assessed how frequently TP was attained in clinical practice and the variation in TP between endoscopists. METHODS : To reach consensus on the definition of TP, international expert endoscopists completed a modified Delphi consensus process. The achievement of TP was then applied to clinical practice. Prospectively collected data in two endoscopy services were retrospectively evaluated. Data on colonoscopies performed for symptoms or surveillance between 1 January 2018 and 1 August 2021 were analyzed. RESULTS : The Delphi consensus process was completed by 20 of 27 invited experts (74.1 %). TP was defined as a colonoscopy fulfilling the following items: explicit colonoscopy indication; successful cecal intubation; adequate bowel preparation; adequate withdrawal time; acceptable patient comfort score; provision of post-polypectomy surveillance recommendations in line with guidelines; and the absence of the use of reversal agents, early adverse events, readmission, and mortality. In the two endoscopy services studied, TP was achieved in 5962/8227 colonoscopies (72.5 %). Of 48 endoscopists performing colonoscopy, attainment of TP varied significantly, ranging per endoscopist from 41.0 % to 89.1 %. CONCLUSION : This study proposes a new composite measure for colonoscopy, namely "textbook process." TP gives a comprehensive summary of performance and demonstrates significant variation between endoscopists, illustrating the potential benefit of TP as a measure in future quality assessment programs.
高质量的结肠镜检查对于患者的良好预后至关重要。“教科书式结局”已被证明是外科中心之间质量保证的可行多维衡量标准。在这项研究中，我们试图建立“教科书式流程”（TP）作为优化结肠镜检查流程的新综合衡量标准，并评估在临床实践中TP 的实现频率以及内镜医生之间的 TP 差异。方法：为了就 TP 的定义达成共识，国际专家内镜医生完成了一项改良 Delphi 共识过程。然后将 TP 的实现应用于临床实践。回顾性评估了在两个内镜服务中前瞻性收集的数据。分析了 2018 年 1 月 1 日至 2021 年 8 月 1 日期间因症状或监测而行的结肠镜检查的数据。结果：27 名受邀专家中有 20 名（74.1%）完成了 Delphi 共识过程。TP 被定义为满足以下项目的结肠镜检查：明确的结肠镜检查指征；成功插管盲肠；充分的肠道准备；足够的退镜时间；可接受的患者舒适度评分；根据指南提供息肉切除后监测建议；并且不使用反转剂、早期不良事件、再入院和死亡。在所研究的两个内镜服务中，8227 例结肠镜检查中有 5962 例（72.5%）达到 TP。在 48 名进行结肠镜检查的内镜医生中，TP 的实现程度差异显著，每位内镜医生的 TP 实现率从 41.0%到 89.1%不等。结论：本研究提出了一种新的结肠镜检查综合衡量标准，即“教科书式流程”。TP 全面总结了表现，并展示了内镜医生之间的显著差异，表明 TP 作为未来质量评估计划中的衡量标准具有潜在益处。
