USING THE ESGE QUALITY CHECK APP IN A NON-ACADEMIC ENDOSCOPY UNIT: HOW MUCH DOES IT COST AND WHAT ARE THE BARRIERS ?

Aims The aim was to assess the human resources and potential barriers for implementing ESGE performance measures (PM) in upper gastrointestinal (UGI) endoscopy, using the ESGE QIC Quality Check App (QIC app).

Methods In one non-academic endoscopy unit, PMs from 300 UGI endoscopy reports were entered into the QIC app to calculate the pre-training unit performance.

The electronic reporting software (ERS) was adapted to integrate PM.

During a training meeting, we presented to endoscopists the results of the pre-training audit, ESGE PM concept and updated ERS.

After a 3-month implementation phase, PMs from 300 UGI endoscopies were re-assessed (post-training audit).

Barriers for implementation were assessed by a questionnaire to the endoscopists after post-training audit.

We calculated human resources (time-allocation) needed for implementation of the quality project.

Results The pre-/post-training PM's results are presented in Table 1.

Resources time-cost and reported barriers for implementing PM are presented in [Figure 1].

Fig. 1

Although both KPM and mPM improved after 3 months, only 2 KPM (1&4) and 2 mPM (4&5) reached the minimum target.

Table 1

Performance Measure	Pre-training (%)	Post-training (%)	Target (%)
Key Performance Measure (KPM)
-KPM 1: fasting instructions prior to UGI endoscopy	0	100	≥95
-KPM 2: documentation of procedure duration	0	84	≥90
-KPM 3: accurate photodocumentation of anatomical landmarks and abdnomal findings	0	82	≥90
-KPM 4: accurate application of standardized disease-related terminology	93	98	≥95
-KPM 5: application of Seattle protocol in Barrett’s surveillance	20	75	≥90
-KPM 6: accurate registration of complications after therapeutic UGI endoscopy	0	39	≥95
Minor Performance Measure (mPM)
-mPM 1: min. 7' procedure time for first diagnostic UGI endoscopy and follow-up of gastric intestinal metaplasia	0	67	≥90
-mPM 2: min. 1' inspection time per cm circumferential Barrett's epithelium	0	37.5	≥90
-mPM 3: use of Lugol chromoendoscopy in patients with a curatively treated ENT or lung cancer to exclude a second primary esophageal cancer	50	Not analysable	≥90
- mPM 4: application of a validated biopsy protocol to detect gastric intestinal metaplasia (MAPS guidelines)	82	97	≥90
- mPM 5: prospective registration of Barrett’s patients	0	100	≥85

Conclusions Our analysis showed a reasonable time allocation for implementation of UGI PMs using the ESGE QIC app. In particular, after training and minimal adaptation of the IT system, a service audit with a sample of 300 UGI can be performed in less than 3 working days. Since this is required only once a year, this seems a reasonable price in human resources.

Proper ERS integrating user-friendly PM reporting and automated PM extraction are the cornerstone for facilitating implementation of PM in endoscopy.

Publication History

Article published online:
14 April 2022