108
QUALITY INDICATORS IN COLONOSCOPY: EXPERIENCE AT A CANADIAN ACADEMIC CENTRE BEFORE AND AFTER AN EDUCATIONAL INTERVENTION
R Berger, S Gruchy, K Crawford, D MacIntosh
Dalhousie University, Halifax, Nova Scotia
Aims: Colonoscopy is a diagnostic and therapeutic tool used to screen for adenomatous polyps and colorectal cancer. Cecal intubation and withdrawal times greater than 6 minutes correlate with higher rates of adenoma detection. Recent guidelines recommend documentation of quality indicators including cecal intubation rates, visualization of anatomic landmarks and withdrawal time. We analyzed current practice at our institution for 2 periods prior to and after an educational intervention.
Methods: All colonoscopies performed by gastroenterologists and general surgeons at the QE II Health Sciences Centre in Halifax were prospectively reviewed for two periods from April to September 2007 and April to September 2008. The primary outcome was cecal intubation rate. Secondary measures included documentation of procedure indication, withdrawal time and visualization of cecal landmarks. Dictated procedure reports were used for data collection. Results of the first data period were presented to the endoscopy group and an educational intervention undertaken. This included a review of current guidelines and feedback on individual performance. A second 6 month period of data was then collected from April to September 2008.
Results: Overall, 2054 colonoscopies were completed. 23.6% of these were screening procedures. The overall cecal intubation rate was 91.3%. The Task Force adjusted cecal intubation rate for screening colonoscopies was 94.6%. Cecal intubation rate (Task Force adjusted) varied from 79.9% to 100% for individual physicians.
Cecal intubation was appropriately documented with anatomic landmarks identified by terminal ileal intubation or visualization of the ileocecal valve and appendiceal orifice in 54.3% of cases during the first study period and 71.0% of cases in the second study period (p<0.05). Documentation of withdrawal time improved from 24.5% to 51.8% of cases after the educational intervention (p<0.05).
Conclusions: At our centre, cecal intubation rates meet current guidelines. There is variability in completion rates amongst individual physicians. The education and individual feedback provided after the first study period improved documentation of both visualization of cecal landmarks and withdrawal time. The standards outlined in current guidelines are still not being met for these quality indicators and ongoing education is necessary.