A quality improvement initiative of implementing pediatric colonoscopy performance metrics at a tertiary medical center
Maireade E. McSweeney, Nishika Virmani, David Johnson, Ramy Yim, Maureen M. Jonas, Victor L. FoxAbstract
Objectives
Current guidelines for pediatric endoscopy have highlighted the importance of engaging in formal quality improvement (QI) processes to enhance procedural performance. We conducted a single‐center, longitudinal QI initiative using standardized colonoscopy performance reports to monitor and improve both individual and facility key performance indicators over time.
Methods
Starting in July 2015, a multidisciplinary QI team developed and distributed standardized colonoscopy performance reports, with the primary aim of improving providers' successful ileal intubation rates to ≥90% by June 30, 2023. Secondary aims included: (1) ensuring mean colonoscopy procedure times of <60 min and (2) compliance with use of our institution's preferred language for documenting adequacy of bowel preparation in ≥95% of colonoscopy reports. We also monitored rates of emergency room visits and hospital admissions within 72 h of the procedure.
Results
A total of 6240 diagnostic colonoscopies by 25 endoscopists over the 8‐year study period were included. Endoscopists' mean terminal ileal intubation rates increased from 89.6% to 93%. Mean duration of colonoscopy remained stable at 43.1 min. Use of a preferred language to document bowel preparation improved from a mean of 89.6%–92.9%. There was no change in post‐procedural emergency room visits and/or hospital admissions.
Conclusion
QI methodology was successfully used to review procedural performance and improve terminal ileal intubation rates, standardize documentation of bowel prep adequacy, and procedural efficiency. Future multi‐center studies are needed to better understand whether ongoing monitoring and reporting of similar pediatric endoscopy performance data could be used to improve endoscopic quality more broadly.