[Quality assurance in coloscopy in private practice and the hospital. The Gastroenterology Quality Circle (GEQC) Munich].
OBJECTIVE
As quality control in medicine is part of a doctor's professional duty, the "Munich Quality Circle" conducted a prospective feasibility study in which ten, previously defined, quality indicators were to be assessed.


METHODS
Six specialised private practice groups and three specialised hospitals centers took part. Data on 2928 consecutive patients were collected by questionnaire and ten quality indicators assessed: concordance with the indication list; intestinal cleansing; premedication; duration and completeness of the study; sensation of pain; use of radiology; complications; diagnosis; and therapeutic intervention.


RESULTS
Concordance with the indication list was present in 97.8% (range 93-100), premedication was given to 94.6% (77-100), midazolam to 77%. The proportion of patients who recorded no or only moderate pain correlated with the dose but not with the duration of advancing the coloscope. Mean time of advancing the instrument to the caecum was 8.0 min, the duration directly depending on the experience of the examiner. A mean time of less than 10 minutes was achieved only after more than 1200 examinations. The more a centre used fluoroscopic control the shorter the time of coloscopy. The examination was completed in 97.6% (92-99). There was no correlation between experience (assuming supervision) and dose of midazolam or frequency of fluoroscopy.


CONCLUSIONS
Nowadays total coloscopy is a primary diagnostic method, but it needs an intensive learning phase. In clinical centers consequent supervision of less experienced examiners achieved comparable results to those with experience. Informative quality indicators for coloscopy can be documented with little cost.
Heldwein
W
W
Medizinische Klinik, Klinikum Innenstadt, Universität München.
Birkner
B
B
Strauch
L
L
König
A
A
D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D003106:Colon / Q000000981:diagnostic imaging; D003113:Colonoscopy / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005762:Gastroenterology; D005858:Germany; D006782:Hospitals, Special / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008332:Management Quality Circles; D008874:Midazolam / Q000008:administration & dosage; D011292:Premedication; D011331:Private Practice / Q000592:standards* / Q000706:statistics & numerical data; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D011859:Radiography; D013997:Time Factors
D018686:Anesthetics, Intravenous; D008874:Midazolam