The Norwegian Gastronet project: Continuous quality improvement of colonoscopy in 14 Norwegian centres.
OBJECTIVE
The burden on colonoscopy capacity is considerable and expected to increase further as colorectal cancer screening programmes gain a foothold in Europe. In this situation, it is particularly important to evaluate the quality of the service given. In this article we present our first year of experience with a quality network of endoscopy centres in Norway (Gastronet).


METHODS
A questionnaire focusing on caecal intubation rate and pain was completed by the endoscopist (on site) and patient (on the day after the examination). Fourteen centres participated with registration of 7370 colonoscopies by 73 endoscopists.


RESULTS
There was 100% endoscopist participation, 87% coverage of colonoscopies and an estimated 76% questionnaire coverage of the patient population. Overall caecal intubation rate was 91%, range 83% to 97% between centres (p < 0.001). Patients reporting severe pain during colonoscopy differed from 2 to 24% between centres (p < 0.001). Variations could only partly be explained by differences in procedure practice (sedation, CO2 insufflation). For individual endoscopists, improvement after feedback on performance was restricted to the group of endoscopists having contributed with only 50-99 registered colonoscopies.


CONCLUSIONS
In quality assurance programmes we recommend a limited number of variables for registration in order to secure high compliance by endoscopists and patients. One year of experience with Gastronet disclosed a satisfactory overall caecal intubation rate, but considerable variation between centres in practice and ability to offer painless colonoscopy. This suggests a need for formal, centralized training of colonoscopists or the development of quality standards for colonoscopy training and practice.
Hoff
Geir
G
Department of Medicine, Telemark Hospital Skien, Norway. hofg@online.no
Bretthauer
Michael
M
Huppertz-Hauss
Gert
G
Kittang
Eirik
E
Stallemo
Asbjørn
A
Høie
Ole
O
Dahler
Stein
S
Nyhus
Sverre
S
Halvorsen
Fred-Arne
FA
Pallenschat
Jens
J
Vetvik
Kåre
K
Kristian Sandvei
Per
P
Friestad
Joachim
J
Pytte
Reidar
R
Coll
Peter
P
D002432:Cecum / Q000473:pathology; D003113:Colonoscopy / Q000379:methods / Q000592:standards*; D006801:Humans; D009664:Norway; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care / Q000592:standards; D011795:Surveys and Questionnaires