Kolber Michael R, Miles Peter J, Shaw Marcus D, Goosen Hilgard, Mok Dereck C M
Department of Family Medicine (Kolber, Goosen); Division of General Surgery (Shaw, Mok, Miles), Department of Surgery, University of Alberta, Edmonton, Alta.
CMAJ Open. 2023 Aug 1;11(4):E654-E661. doi: 10.9778/cmajo.20210237. Print 2023 Jul-Aug.
In Canada, endoscopy is primarily performed by gastroenterologists and surgeons, and some studies report that colonoscopies performed by nongastroenterologists have more complications and higher rates of future colorectal cancer. Our objective was to determine whether rural-based nongastroenterologist endoscopists are achieving quality benchmarks in colonoscopy.
This quality improvement initiative prospectively evaluated 6 key performance indicators (KPIs) (cecal intubations, polyp detection [males and females; for first-time colonoscopies on patients aged ≥ 50 yr], bowel preparations, patient comfort and withdrawal times) on consecutive colonoscopies performed by participating Alberta North Zone endoscopists. The study period was June 2018 to March 2020. Overall and individual endoscopist's KPIs were compared with standard benchmarks. Additional performance indicators included mean number of polyps per colonoscopy and an exploration of study-defined sedation-related level of consciousness.
Data were collected on 6212 colonoscopies performed by 16 endoscopists (9 surgeons, 5 family physicians and 2 internists) in 6 hospitals. All 6 KPI benchmarks were achieved when results were pooled over all endoscopists in the study. Overall, cecal intubation occurred in 6006 of 6209 (96.7%, 95% confidence interval 94.5%-99.0%) cases. Polyp detection was 65.9% (592/898) and 49.8% (348/699) for male and female patients, respectively, aged 50 years or older. Variability in individual endoscopist results existed, especially for the mean number of polyps per 100 colonoscopies and sedation-related level of consciousness.
Overall, Alberta North Zone endoscopists are performing high-quality colonoscopies, collectively achieving all 6 KPIs. To understand endoscopic performance and encourage individual and group reflection on endoscopic practices, Canadian endoscopists are encouraged to participate in similar colonoscopy quality initiative studies.
在加拿大，内镜检查主要由胃肠病学家和外科医生进行，一些研究报告称，非胃肠病学家进行的结肠镜检查有更多并发症，未来患结直肠癌的几率更高。我们的目标是确定以农村为基地的非胃肠病学内镜医师是否达到了结肠镜检查的质量标准。
这项质量改进计划前瞻性地评估了参与研究的艾伯塔省北区内镜医师连续进行的结肠镜检查的6项关键绩效指标（KPI）（盲肠插管、息肉检测[男性和女性；年龄≥50岁患者的首次结肠镜检查]、肠道准备、患者舒适度和退镜时间）。研究期间为2018年6月至2020年3月。将总体和个体内镜医师的KPI与标准基准进行比较。其他绩效指标包括每次结肠镜检查的息肉平均数量以及对研究定义的镇静相关意识水平的探索。
收集了6家医院16名内镜医师（9名外科医生、5名家庭医生和2名内科医生）进行的6212例结肠镜检查的数据。当汇总研究中所有内镜医师的结果时，所有6项KPI基准均得以实现。总体而言，6209例中有6006例（96.7%，95%置信区间94.5%-99.0%）完成了盲肠插管。50岁及以上男性和女性患者的息肉检测率分别为65.9%（592/898）和49.8%（348/699）。个体内镜医师的结果存在差异，尤其是每100例结肠镜检查的息肉平均数量和镇静相关意识水平。
总体而言，艾伯塔省北区的内镜医师正在进行高质量的结肠镜检查，共同实现了所有6项KPI。为了解内镜检查表现并鼓励个人和团体对内镜操作进行反思，鼓励加拿大内镜医师参与类似的结肠镜检查质量改进研究。
