This article is co-published by the
Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.
Following the “First 10-year Plan for Cancer Control” screening program in Korea initiated by the government, the National Cancer Screening Program (NCSP) has been active since 1999 [
Given the variability in performance levels by endoscopists and the introduction of the NCSP, improving the quality of EGD and CS has become an important concern. Recently, many professional societies have published specific quality indicators for endoscopy procedures; however, it is difficult to adopt Western quality indicators in Korea, as these are generally country-specific. To improve the quality of endoscopy in the NCSP, the Korean Society of Gastrointestinal Endoscopy (KSGE) developed the National Endoscopy Quality Improvement Program (NEQIP) [
In this context, the Quality Improvement Committee of the KSGE revised the quality indicators, to be broadly applied by the NEQIP, for EGD and CS in 2017. This paper reports the statements and quality indicators for used for EGD and CS and describes the process applied for the development of these statements and quality indicators.
The Quality Improvement Committee of the KSGE chose to develop a revised edition of the quality indicators for the NEQIP in March 2017 based on the previous quality indicators developed in 2008. The members of the Task Force on Revision of Quality Indicators included 14 gastroenterology professors from the university hospital, and members of the Quality Improvement Committee. At the first meeting, held on May 2017, the scope of the revision was discussed and a decision was made to focus on the NEQIP but not on general endoscopy quality indicators outside of the NCSP. After several meetings and discussions by the Task Force, 29 key statements were selected using a
On October 21, 2017, the draft of the revised statements and quality indicators for NEQIP was presented for a consensus meeting, which was attended by 27 gastrointestinal endoscopy specialists including members of the Task Force in Korea. To determine the level of agreement, each NEQIP statement was classified into five levels of strength of recommendation: “strongly agree”, “agree”, “uncertain”, “disagree”, or “strongly disagree” (
For the selected statements, the levels of recommendation were determined using an online-based voting system. Among the 27 members, 22 (81.5%) participated in this voting scheme to determine the levels of recommendation for the statement. To this end, each NEQIP statement was classified into three levels of strength: “strong”, “intermediate”, or “weak” (
The final level of agreement and recommendations were indicated as a percentage value below the statement and quality indicators in respective tables. The statements and quality indicators were classified into six domains.
Statements and quality indicators were classified into six domains: workforce, process, facilities and equipment, outcome, reprocessing, and sedation. Among the potential 32 statements and 38 quality indicators that were proposed, a consensus agreement was reached for 29 statements and 34 quality indicators after discarding three statements and four quality indicators. The discarded statement and quality indicators were ‘examination time for EGD’, ‘documentation of complications of CS’, and ‘adenoma detection rate over 40%’. All the participants agreed on the importance of these discarded quality indicators, but they postponed their acceptance as they were considered too premature to be accepted as quality indicators for the NEQIP in Korea. Finally, a total of 29 statements (
The domain for the workforce is composed of four statements (
There is insufficient evidence regarding the adequate duration of and methods for gastrointestinal endoscopy training. In general, supervised gastrointestinal endoscopy training is recommended for at least one year in Korea. With regard to the optimal volume of supervised EGD procedures, 1,000 cases are recommended by both the KSGE and the Japan Gastroenterological Endoscopy Society, but only 130 cases are recommended by the American Society for Gastrointestinal Endoscopy (ASGE) [
For CS training, at least 1 year of supervised CS training is recommended by both the KSGE and the Korean Society of Coloproctology [
It is well known that high-quality gastrointestinal endoscopy should be performed despite the variability in detection rates and performance by endoscopists. Yalamarthi et al. [
Endoscopists must continuously receive endoscopic education to maintain endoscopic performance skills and be updated on the clinical aspects of gastrointestinal diseases at an optimal level to provide the best care [
The process domain is composed of 10 statements (
Photo-documentation should be performed after careful inspection of the EGD. For EGD procedures, at least eight images should be taken, and complementary images should certainly be taken in the case of a pathologic lesion. The order in which standard images are taken will differ for each endoscopist, and it is important for the endoscopist to take images according to his or her routine so as not to miss any region. The European Society of Gastrointestinal Endoscopy recommends photo-documentation of at least 10 representative images of each of the following anatomical landmarks: the duodenum, major ampulla, antrum, angulus, fundus in inversion, greater curvature of the proximal body, greater curvature of the distal body, squamocolumnar junction, upper esophagus, and lower esophagus [
The domain concerning facilities and equipment comprised two statements (
The domain concerning outcome consists of four statements (
In this revision, the levels of agreement and recommendation for the outcome domain were relatively high. Nonetheless, the strength of recommendation for the statement and quality indicators for
The domain of reprocessing is composed of six statements (
However, it is difficult to evaluate the appropriate level of endoscopic reprocessing training for all workers in an actual clinical practice setting. Therefore, over 50% of endoscopists and reprocessing personnel are required to complete endoscopic reprocessing education programs to participate in the NCSP in Korea [
The domain of sedation is composed of three statements (
Considering that many endoscopy units perform both EGD and CS in accordance with the NCSP, statements and quality indicators were not described separately for EGD and CS procedures. In this revision, the level of evidence for quality indicators was suggested by binary description of the statement and quality indicator, and the level of agreement and strength of recommendation were presented. However, a limitation of this revision was that optimal performance targets for each quality indicator were not established, since the performance level of each endoscopist may vary and suitable evidence regarding performance measures in the literature was lacking. Given that the outcome measure is the most important objective in the NEQIP, the introduction of many quality indicators of outcome measure was considered. Nevertheless, another limitation of this revision was that the outcome indicators were difficult to introduce due to the lack of consensus even among experts. Since the adenoma detection rate and detection rates of gastric cancer or CRC, which are the representative outcome measures, are longitudinal measures that are derived by analyzing long-term data, it is likely that a registry system is preferable to on-site evaluation. Data relative to adverse events and complications are likely to be missed, even if they are introduced as outcome indicators; thus, further deliberation as to how to evaluate the patient’s experience and safety profile is necessary. The NEQIP is processed by document evaluation and on-site evaluation within the activity of the NCSP; however, as this revision did not focus on quality indicators optimized for document evaluation, further study is needed in that specific area. It is also important to establish a research environment that can actively investigate quality issues relative to the NCSP, since it is more appropriate to develop quality indicators based on scientific evidence rather than expert opinion for greater objectivity.
Ongoing revisions are not an absolute standard in clinical practice. Medical practice for individual patients should be determined by the attending physician considering the overall condition and situation of each patient. This revision should not be used for the purposes of restricting the medical practice of clinicians as a standard for health insurance review, or for formulating legal judgment as to the medical management of a specific patient.
Levels of Agreement and Recommendation
Definition |
---|
Level of agreement |
A: Strongly agree with the statement and quality indicators |
B: Agree with the statement and quality indicators |
C: Uncertain of the statement and quality indicators |
D: Disagree with the statement and quality indicators |
E: Strongly disagree with the statement and quality indicators |
Level of recommendation |
Strong: Recommendation likely to apply to most National Cancer Screening Program endoscopy settings |
Intermediate: Recommendation, best action may differ according to particular circumstances or patients in National Cancer Screening Program endoscopy settings |
Weak: Recommendation, alternative approaches likely to be better under some circumstances in National Cancer Screening Program endoscopy settings |
Final Statements and Their Level of Agreement for Esophagogastroduodenoscopy and Colonoscopy in the National Cancer Screening Program: Workforce, Process, Facilities and Equipment, and Outcome
Statements |
---|
Workforce |
An experienced endoscopist with sufficient training in EGD should perform EGD. (EGD) |
[Level of agreement: strongly agree 95.2%, agree 4.8%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
An experienced endoscopist with sufficient training in colonoscopy should perform colonoscopy. (CS) |
[Level of agreement: strongly agree 96.0%, agree 4.0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
An endoscopist who performs endoscopies is required to receive continuous endoscopy education. (EGD/CS) |
[Level of agreement: strongly agree 100%, agree 0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
Endoscopy nursing staff is required to receive training for endoscopy quality improvement. (EGD/CS) |
[Level of agreement: strongly agree 91.3%, agree 8.7%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 81.8%, intermediate 18.2%, weak 0%] |
Process |
Clinicians should verify the overall condition of the patient before EGD. (EGD) |
[Level of agreement: strongly agree 95.8%, agree 4.2%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
Clinicians should verify the fasting state, general health status, previous medical history, current medication history including anti-platelets or anticoagulants (antithrombotics), and quality of bowel preparation before colonoscopy. (CS) |
[Level of agreement: strongly agree 95.7%, agree 4.4%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
Clinicians should provide bowel preparation education to examinees before colonoscopy. (CS) |
[Level of agreement: strongly agree 95.7%, agree 4.4%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
Clinicians should provide a sufficient explanation of the procedure and obtain informed consent before colonoscopy. (CS) |
[Level of agreement: strongly agree 95.8%, agree 4.2%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
All of the standard imaging sites of EGD should be clearly photographed and stored as image records. (EGD) |
[Level of agreement: strongly agree 91.3%, agree 8.7%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 86.4%, intermediate 13.6%, weak 0%] |
All of the standard imaging sites of colonoscopy should be clearly photographed and stored as image records. (CS) |
[Level of agreement: strongly agree 91.3%, agree 8.7%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 81.8%, intermediate 18.2%, weak 0%] |
Average withdrawal time in negative-result colonoscopies should be measured and should not be ≥6 min. (CS) |
[Level of agreement: strongly agree 70.8%, agree 29.2%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 72.7%, intermediate 27.3%, weak 0%] |
After EGD, the clinician should instruct the examinee as to the post-procedure precautions and how to obtain exam results. (EGD) |
[Level of agreement: strongly agree 91.3%, agree 8.7%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 81.8%, intermediate 18.2%, weak 0%] |
After colonoscopy, the clinician should instruct the examinee as to the post-procedure precautions and how to obtain exam results. (CS) |
[Level of agreement: strongly agree 95.8%, agree 4.2%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 86.4%, intermediate 13.6%, weak 0%] |
The tissue sample obtained during endoscopy should be managed properly according to specific protocols. (EGD/CS) |
[Level of agreement: strongly agree 91.7%, agree 8.3%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 90.9%, intermediate 9.1%, weak 0%] |
Facilities and equipment |
The endoscopy unit should be an independent facility from the outpatient clinic. (EGD/CS) |
[Level of agreement: strongly agree 92.3%, agree 3.9%, uncertain 3.9%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 77.3%, intermediate 22.7%, weak 0%] |
Clinicians should be prepared for complications and emergency situations during endoscopy. (EGD/CS) |
[Level of agreement: strongly agree 100%, agree 0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
Outcome |
Endoscopy reports should be recorded with high accuracy. (EGD/CS) |
[Level of agreement: strongly agree 100%, agree 0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
Pathologic findings identified during endoscopy should be precisely described. (EGD/CS) |
[Level of agreement: strongly agree 95.8%, agree 4.2%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 95.5%, intermediate 4.5%, weak 0%] |
|
[Level of agreement: strongly agree 78.3%, agree 21.7%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 63.6%, intermediate 36.4%, weak 0%] |
Bowel preparation should be adequate for a thorough colonoscopy. (CS) |
[Level of agreement: strongly agree 100%, agree 0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 90.9%, intermediate 9.1%, weak 0%] |
EGD, esophagogastroduodenoscopy; CS, colonoscopy.
Final Statements and Their Level of Agreement for Esophagogastroduodenoscopy and Colonoscopy in the National Cancer Screening Program: Reprocessing and Sedation
Statements |
---|
Reprocessing |
Endoscopy reprocessing and disinfection guidelines approved by the Endoscopy Professional Association should be available in each endoscopy unit. (EGD/CS) |
[Level of agreement: strongly agree 94.1%, agree 5.9%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 86.4%, intermediate 13.6%, weak 0%] |
Endoscopic reprocessing procedures should be performed as directed by established protocols and guidelines. (EGD/CS) |
[Level of agreement: strongly agree 100%, agree 0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
Endoscopic accessories that pass through the mucosa, such as biopsy forceps or incision instruments, must be sterilized. (EGD/CS) |
[Level of agreement: strongly agree 100%, agree 0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
Personnel performing endoscopic reprocessing and disinfection should wear personal protective equipment. (EGD/CS) |
[Level of agreement: strongly agree 72.7%, agree 22.7%, uncertain 4.6%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 54.6%, intermediate 45.4%, weak 0%] |
Endoscopic reprocessing equipment and storage methods should be appropriate as directed by guidelines. (EGD/CS) |
[Level of agreement: strongly agree 100%, agree 0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 90.9%, intermediate 9.1%, weak 0%] |
Endoscopists and reprocessing workers should complete endoscopic reprocessing education programs approved by the Endoscopy Professional Association. (EGD/CS) |
[Level of agreement: strongly agree 95.0%, agree 5.0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 90.9%, intermediate 9.1%, weak 0%] |
Sedation |
Pre-sedation history, risk assessment, and sedation-specific informed consent should be obtained for sedative endoscopy. (EGD/CS) |
[Level of agreement: strongly agree 100%, agree 8.7%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
During sedative endoscopy, the patient’s vital signs should be monitored and documented. (EGD/CS) |
[Level of agreement: strongly agree 100%, agree 0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 90.9%, intermediate 9.1%, weak 0%] |
Patients should be monitored with discharge assessment scales after sedative endoscopy. (EGD/CS) |
[Level of agreement: strongly agree 100%, agree 0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 90.9%, intermediate 9.1%, weak 0%] |
EGD, esophagogastroduodenoscopy; CS, colonoscopy.
Final Quality Indicators and Their Level of Agreement for Esophagogastroduodenoscopy and Colonoscopy in the National Cancer Screening Program: Workforce, Process, Facilities and Equipment, and Outcome
Quality indicators |
---|
Is the EGD for the NCSP performed by specialists with at least one year of supervised endoscopy training or endoscopists with experience of at least 500 or more EGD procedures? (EGD) |
□ Specialists with at least one year of supervised endoscopy training |
□ Endoscopist with experience of at least 500 or more EGDs |
□ Endoscopist without one year of supervised endoscopy training or experience of less than 500 EGDs |
[Level of agreement: strongly agree 61.9%, agree 38.1%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 77.3%, intermediate 22.7%, weak 0%] |
Is the colonoscopy of the NCSP performed by a specialist with at least one year of supervised colonoscopy training in more than 150 cases or an endoscopist with experience of at least 300 or more successful colonoscopies? (CS) |
□ Specialist with one year of supervised colonoscopy training with over 150 cases |
□ Endoscopist with experience of 300 or more successful colonoscopies |
□ Endoscopist without one year of supervised endoscopy training or experience of less than 300 successful colonoscopies |
[Level of agreement: strongly agree 66.7%, agree 33.3%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 77.3%, intermediate 22.7%, weak 0%] |
Did the endoscopist perform at least 300 EGDs during the 3-year ‘National Endoscopy Quality Improvement Program’? (EGD) |
□ Yes □ No |
[Level of agreement: strongly agree 13.6%, agree 50.0%, uncertain 36.4%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 59.1%, intermediate 31.8%, weak 9.1%] |
Did the endoscopist perform at least 150 colonoscopies during the 3-year ‘National Endoscopy Quality Improvement Program’? (CS) |
□ Yes □ No |
[Level of agreement: strongly agree 37.5%, agree 54.2%, uncertain 4.2%, disagree 4.2%, strongly disagree 0%] |
[Level of recommendation: strong 54.6%, intermediate 40.9%, weak 4.5%] |
Did the endoscopist the complete at least 12 hours of endoscopy-related education courses during the 3-year ‘National Endoscopy Quality Improvement Program’? (EGD/CS) |
□ Yes □ No |
How many hours of endoscopy-related education courses did the endoscopist attend over the past 3 years? (EGD/CS) ( ) Hours |
[Level of agreement: strongly agree 36.7%, agree 33.3%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 81.8%, intermediate 18.2%, weak 0%] |
How often did endoscopic nursing staff participate in training for endoscopy quality improvement over the past 3 years? (EGD/CS) |
□ More than 3 times □ More than 1 time □ None |
[Level of agreement: strongly agree 66.7%, agree 33.3%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 54.6%, intermediate 40.9%, weak 4.5%] |
Does the clinician verify the fasting state, general health status, past medical history, and medication history including anti-platelets or anticoagulants (antithrombotics) using a pre-procedure checklist before endoscopy? (EGD/CS) |
□ Yes □ No |
[Level of agreement: strongly agree 96.0%, agree 4.0%, uncertain 36.4%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 90.9%, intermediate 9.1%, weak 0%] |
Does the clinician educate examinees on bowel preparation and provide colonoscopy information before examination? (CS) |
□ Yes □ No |
[Level of agreement: strongly agree 54.6%, agree 31.8%, uncertain 9.1%, disagree 4.6%, strongly disagree 0%] |
[Level of recommendation: strong 86.4%, intermediate 13.6%, weak 0%] |
Does the endoscopist obtain written informed consent for the risks and benefits associated with colonoscopy? (CS) |
□ Yes □ No |
[Level of agreement: strongly agree 91.3%, agree 8.7%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 86.4%, intermediate 13.6%, weak 0%] |
Does the endoscopist photograph and record at least 8 clear standard EGD images? (EGD) |
□ Excellent □ Fair □ Poor |
[Level of agreement: strongly agree 73.9%, agree 21.7%, uncertain 4.4%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 86.4%, intermediate 13.6%, weak 0%] |
Does the endoscopist photograph and record at least 8 clear standard colonoscopy images including the maximal insertion site (e.g., the cecum)? (CS) |
□ Excellent □ Fair □ Poor |
[Level of agreement: strongly agree 77.3%, agree 22.7%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 86.4%, intermediate 13.6%, weak 0%] |
Does the endoscopist maintain an average withdrawal time of ≥6 min in negative-result colonoscopies in order to inspect the colon mucosa sufficiently? (CS) |
□ Yes □ No |
[Level of agreement: strongly agree 87.5%, agree 12.5%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 77.3%, intermediate 22.7%, weak 0%] |
Does the clinician instruct the examinee as to the precautions and how to check the results after EGD? (EGD) |
□ Yes □ No |
[Level of agreement: strongly agree 85.7%, agree 14.3%, uncertain 4.4%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 81.8%, intermediate 18.9%, weak 0%] |
Does the clinician instruct the examinee as to the post-procedure precautions and how to obtain examination results after colonoscopy? (CS) |
□ Yes □ No |
[Level of agreement: strongly agree 91.7%, agree 8.3%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 81.8%, intermediate 18.9%, weak 0%] |
Does the clinician label the tissue sample obtained during endoscopy? (EGD/CS) |
□ Yes □ No |
[Level of agreement: strongly agree 100%, agree 0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 90.9%, intermediate 9.1%, weak 0%] |
Is the endoscopy unit separate from the outpatient clinic? (EGD/CS) |
□ Excellent □ Fair □ Poor |
[Level of agreement: strongly agree 92.3%, agree 3.9%, uncertain 3.9%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 86.4%, intermediate 13.6%, weak 0%] |
Are endoscopic treatment devices (① injection catheter, ② hemoclips) and resuscitation equipment available for the management of adverse events during endoscopy? (EGD/CS) |
□ Yes □ No |
[Level of agreement: strongly agree 84.0%, agree 16.0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 90.9%, intermediate 9.1%, weak 0%] |
Does the EGD report include all of the following items? (EGD) (1) date of examination; (2) patient information: name, sex and age; (3) name of endoscopist; (4) medications; (5) diagnosis; (6) findings; (7) biopsy details; and (8) complications, if any. |
[Level of agreement: strongly agree 95.8%, agree 4.2%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 95.5%, intermediate 4.5%, weak 0%] |
Does the colonoscopy report include all of the following items? (CS) (1) date of examination; (2) patient information: name, sex, and age; (3) name of endoscopist; (4) medications; (5) diagnosis; (6) findings; (7) biopsy details; and (8) quality of bowel preparation (or maximum insertion site); (9) cecal intubation, (10) withdrawal time; and (11) complications, if any. |
[Level of agreement: strongly agree 66.7%, agree 25.0%, uncertain 8.3%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 77.3%, intermediate 18.2%, weak 4.5%] |
When a pathologic finding is observed, how well are the location, size, and shape of the lesion documented? (EGD/CS) |
□ Excellent □ Fair □ Poor |
[Level of agreement: strongly agree 87.5%, agree 12.5%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 95.6%, intermediate 4.4%, weak 0%] |
Do you test the |
□ Yes □ No |
Does the endoscopist test for |
□ Yes □ No |
[Level of agreement: strongly agree 66.7%, agree 20.8%, uncertain 12.5%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 63.6%, intermediate 36.4%, weak 0%] |
Is the proportion of patients who achieved adequate bowel preparation higher than 85%? |
□ Yes □ No |
[Level of agreement: strongly agree 41.7%, agree 54.2%, uncertain 4.2%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 40.9%, intermediate 59.1%, weak 0%] |
EGD, esophagogastroduodenoscopy; NCSP, National Cancer Screening Program; CS, colonoscopy.
Final Quality Indicators and Their Level of Agreement for Esophagogastroduodenoscopy and Colonoscopy in National Cancer Screening Program: Reprocessing and Sedation
Quality indicators |
---|
Does the Endoscopy unit have ‘Endoscopy reprocessing and disinfection protocols’ approved by the Endoscopy Professional Association? (EGD/CS) |
□ Yes □ No |
[Level of agreement: strongly agree 95.2%, agree 4.8%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 86.4%, intermediate 13.6%, weak 0%] |
Are the endoscopic reprocessing procedures performed properly as directed by specific protocols? (EGD/CS) |
□ Excellent □ Fair □ poor |
[Level of agreement: strongly agree 95.7%, agree 4.4%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
Are high-level disinfectants used during endoscopy reprocessing? (EGD/CS) |
□ Yes □ No |
[Level of agreement: strongly agree 100%, agree 0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 95.5%, intermediate 4.5%, weak 0%] |
Do reprocessing personnel follow the disinfectant procedures during endoscopy reprocessing? (EGD/CS) |
□ Check both the disinfectant instructions and protocols regarding disinfectant management |
□ Check only disinfectant instructions |
□ Check only procedures of disinfectant management |
[Level of agreement: strongly agree 90.5%, agree 9.5%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 86.4%, intermediate 13.6%, weak 0%] |
Are the endoscopic accessories that pass through the mucosa, such as biopsy forceps or incision instruments, disposable or sterilized for reuse in the case of reusable products? (EGD/CS) |
□ Yes □ No |
[Level of agreement: strongly agree 90.5%, agree 9.5%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 100%, intermediate 0%, weak 0%] |
Do reprocessing personnel wear personal protective equipment? (EGD/CS) |
□ Yes □ No |
[Level of agreement: strongly agree 80.0%, agree 20.0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 50.0%, intermediate 50.0%, weak 0%] |
Is there an appropriate reprocessing area separate from the endoscopy examination room? (EGD/CS) |
□ Excellent □ Fair □ Poor |
Is there an appropriate reprocessing room separate from the endoscopy unit? (EGD/CS) |
□ Excellent □ Fair □ Poor |
[Level of agreement: strongly agree 90.0%, agree 10.0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 72.3%, intermediate 22.7%, weak 0%] |
Are endoscopes kept in a dedicated endoscope storage cabinet where the tip of endoscope does not touch the bottom surface of the storage cabinet? (EGD/CS) |
□ Excellent □ Fair □ Poor |
[Level of agreement: strongly agree 85.0%, agree 15.0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 90.9%, intermediate 9.1%, weak 0%] |
Do endoscopists and reprocessing personnel complete endoscopic reprocessing education programs approved by the Endoscopy Professional Association? (EGD/CS) |
□ Excellent □ Fair □ Poor |
[Level of agreement: strongly agree 83.3%, agree 16.7%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 90.9%, intermediate 9.1%, weak 0%] |
Does the clinician document the pre-sedation history and risk assessment and obtain sedation-specific informed consent separately? |
□ Excellent □ Fair □ Poor |
[Level of agreement: strongly agree 95.0%, agree 5.0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 95.5%, intermediate 4.5%, weak 0%] |
Does the clinician monitor and record patient status (oxygen saturation, blood pressure, pulse rate), type and dose of sedatives, and adverse events during sedative endoscopy? (EGD/CS) |
□ Yes □ No |
[Level of agreement: strongly agree 89.5%, agree 10.5%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 90.9%, intermediate 9.1%, weak 0%] |
Does the clinician monitor patients using a standardized discharge scoring system after sedative endoscopy? (EGD/CS) |
□ Yes □ No |
[Level of agreement: strongly agree 95.0%, agree 5.0%, uncertain 0%, disagree 0%, strongly disagree 0%] |
[Level of recommendation: strong 83.4%, intermediate 13.6%, weak 0%] |
EGD, esophagogastroduodenoscopy; CS, colonoscopy.