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113

ENDOSCOPY UNIT QUALITY INDICATORS FOR COLONOSCOPY: THE CANADIAN ASSOCIATION OF GASTROENTEROLOGY (CAG) ENDOSCOPY QUALITY INITIATIVE (EQI) PILOT PROJECT

D Armstrong1, R Hollingworth2, D MacIntosh3, Y Chen1, R Bridges4, S Daniels5, S Gittens6, P Sinclair5, J Cabrera4, C Dube4

1Division of Gastroenterology, McMaster University, Hamilton; 2Division of Gastroenterology, The Credit Valley Hospital, Mississauga, Ontario; 3Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia; 4Division of Gastroenterology, University of Calgary, Calgary, Alberta; 5Canadian Association of Gastroenterology, Oakville, Ontario; 6ECD Solutions, Atlanta, Georga, USA
Background: Endoscopy units’ delivery of timely service, consistent with published guidelines (Can J Gastro 2006;20:411) depends, partly, on efficient use of available resources. However, there is no mechanism to allow direct widespread monitoring of systemic quality indicators, such as booking appropriateness and bowel preparation adequacy in Canadian endoscopy units.
Aims: To determine endoscopy unit quality indicators in the context of a national colonoscopy practice audit program.
Methods: MDs at 13 centres collected data, in real time, on colonoscopies performed over periods of at least 2 weeks using data collection software (ReForm XT, Goanyware Software, Tulsa, OK) on a smartphone (Treo 650, Palm Inc, Mississauga, ON) with prompt download to a secure website and presentation on a secure website (ECD solutions, Atlanta, GA) for participants’ review. Reasons for colonoscopy were classified as ‘Investigation of abnormality’ (INV), ‘Screening’ (SCR) and ‘Surveillance’ (SUR). Bowel preparation quality was rated with the Ottawa scale (Scores- Excellent: 0-4; Poor: 11-14).
Results: Since February 2008, 45 endoscopists (34 GIs and 11 surgeons) reported on 822 colonoscopies. Bowel preparation was: excellent: 73.9% and poor: 2.7%.
Conclusions: Colonoscopy intervals seem appropriate and most patients have good bowel preparation. However, for SCR patients, 20% are =<50 yrs old, >10% have had a colonoscopy within <5 yrs and 8% are >70 yrs old.
Point-of-care data collection on reasons for colonoscopy and bowel preparation quality permit: 1) practice audit by physicians and endoscopy units, and 2) improved resource utilization in the delivery of colonoscopy services.
Percentages [95% CI] of patients with respect to interval since last colonoscopy and age
Interval (yrs) INV (N=353) SCR (N=324) SUR (N=145)
Never 72.5 (67.6-77.1) 62.7 (57.1-67.9) 3.4 (1.1-7.9)
< 1 6.2 (4.0-9.3) - 6.2 (2.9-11.5)
1-2 4.5 (2.6-7.3) 1.2 (0.3-3.1) 17.9 (12.1-25.2)
3-5 8.8 (6.0-12.2) 11.4 (8.2-15.4) 40.0 (32.0-48.5)
6-10 4.8 (2.8-7.6) 21.6 (17.3-26.5) 28.3 (21.1-36.4)
>10 3.1 (1.6-5.5) 3.1 (1.5-5.6) 4.1 (1.5-8.8)
Patient age (yrs)      
18-40 15.9 (12.2-20.1) 4.0 (2.2-6.8) 11.0 (6.4-17.3)
41-50 18.4 (14.5-22.9) 16.0 (12.2-20.5) 13.1 (8.1-19.7)
51-60 26.3 (21.8-31.3) 41.0 (35.6-46.6) 24.8 (18.0-32.7)
61-70 18.4 (14.5-22.9) 30.6 (25.6-35.9) 31.0 (23.6-39.2)
>70 21.0 (16.8-25.6) 8.3 (5.6-11.9) 20.0 (13.8-27.4)

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