A novel colonoscopy reporting system enabling quality assurance

Background and study aims: The quality of colonoscopy can only be measured if colonoscopy reports include all key quality indicators. In daily practice, reporting is often incomplete and not standardized. This study describes a novel, structured colonoscopy reporting system, which aims to generate standardized and complete reports and to facilitate the automatic analysis of colonoscopy quality indicators.

Methods: A new colonoscopy reporting system (EndoALPHA) was developed. The system reports all colonoscopy quality indicators, as well as pathological findings, in a systematic manner using structured terminology. All essential items carry specific codes, which enables statistical analysis and the automatic generation of reports of all quality indicators. The EndoALPHA reporting system was tested with regard to completeness of reporting and evaluation of quality indicators both for individual endoscopists and the endoscopy unit.

Results: In 2012, all 810 colonoscopies performed at one colonoscopy center were documented using EndoALPHA. Overall, 94 % of performed colonoscopies were reported completely using the encoded terminology. Individual unadjusted cecal intubation rates were above 90 % for all endoscopists (mean 96.7 %), and the adenoma detection rate was above 20 % for all endoscopists (35.4 % for the unit).

Conclusion: The novel EndoALPHA reporting system enables automatic quality assessment on two levels: the completeness of reporting can be evaluated, and if this is adequate, the quality of the colonoscopies can also be assessed. Integrated with feedback, benchmarking and training, the reporting system may facilitate quality improvement for colonoscopy services.

• References

• 1 Zauber AG, Winawer SJ, O’Brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
• 2 Singh H, Nugent Z, Demers AA et al. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology 2010; 139: 1128-1137
• 3 Bressler B, Paszat LF, Vinden C et al. Colonoscopic miss rates for right-sided colon cancer: a population-based analysis. Gastroenterology 2004; 127: 452-456
• 4 Baxter NN, Goldwasser MA, Paszat LF et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med 2009; 150: 1-8
• 5 Brenner H, Hoffmeister M, Arndt V et al. Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J Natl Cancer Inst 2010; 102: 89-95
• 6 Bressler B, Paszat LF, Zhongliang C et al. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 2007; 132: 96-102
• 7 Van Rijn JC, Reitsma JB, Stoker J et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol 2006; 101: 343-350
• 8 Kaminski MF, Regula J, Kraszewska E. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
• 9 Rex DK, Petrini JL, Baron TH et al. Quality indicators for colonoscopy. Am J Gastroenterol 2006; 101: 873-885
• 10 National Health Service Bowel Cancer Screening Programme Endoscopy Quality Assurance Group. Quality assurance guidelines for colonoscopy publication no. 6. National Health Service; 2011 http://www.cancerscreening.nhs.uk/bowel/publications/nhsbcsp06.pdf
• 11 RIVM, National Institute for Public Health and the Environment, NVMDL (Netherlands Association of Gastroenterohepatologists). Protocol for the authorization and auditing of colonoscopy centres and endoscopists – National screening programme for bowel cancer – the Netherlands. Version 1. 06/2012 http://www.rivm.nl/dsresource?objectid=rivmp:186626&type=org&disposition=inline
• 12 Barclay RL, Vicari JJ, Doughty AS et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006; 355: 2533-2541
• 13 Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc 2003; 58: 76-79
• 14 Robertson DJ, Lawrence LB, Shaheen NJ et al. Quality of colonoscopy reporting: a process of care study. Am J Gastroenterol 2002; 97: 2651-2656
• 15 Li J, Nadel MR, Poppell CF et al. Quality assessment of colonoscopy reporting: results from a statewide cancer screening program. Diagn Ther Endosc 2010; pii: 419796
• 16 Lieberman D, Nadel M, Smith RA et al. Standardized colonoscopy reporting and data system: report of the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. Gastrointest Endosc 2007; 65: 757-766
• 17 Lieberman DA, Faigel DO, Logan JR et al. Assessment of quality of colonoscopy reports: results from a multi-center consortium. Gastrointest Endosc 2009; 69: 645-653
• 18 Beaulieu D, Barkun A, Martel M. Quality audit of colonoscopy reports amongst patients screened or surveilled for colorectal neoplasia. World J Gastroenterol 2012; 18: 3551-3557
• 19 de Jonge V, Sint Nicolaas J, Cahen DL et al. Quality evaluation of colonoscopy reporting and colonoscopy performance in daily clinical practice. Gastrointest Endosc 2012; 75: 98-106
• 20 Froehlich F, Wietlisbach V, Gonvers JJ et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc 2005; 61: 378-384
• 21 Taber A, Romagnuolo J. Effect of simply recording colonoscopy withdrawal time on polyp and adenoma detection rates. Gastrointest Endosc 2010; 71: 782-786
• 22 de Wijkerslooth TR, de Haan MC, Stoop EM et al. Burden of colonoscopy compared to non-cathartic CT-colonography in a colorectal cancer screening programme: randomised controlled trial. Gut 2012; 61: 1552-1559
• 23 Practice guidelines for sedation and analgesia by non-anesthesiologists. An updated report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Anesthesiology 2002; 96: 1004-1017
• 24 Rostom A, Ross ED, Dubé C et al. Development and validation of a nurse-assessed patient comfort score for colonoscopy. Gastrointest Endosc 2013; 77: 255-261
• 25 Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 37: 570-578
• 26 Coe SG, Panjalab C, Heckman MG et al. Quality in colonoscopy reporting: An assessment of compliance and performance improvement. Dig Liver Dis 2012; 44: 660-664