title: Effectiveness of a continuous quality improvement program on colonoscopy practice.
abstract: OBJECTIVE
  Continuous quality improvement (CQI) is recommended by professional societies as part of every colonoscopy program, but little is known with regard to its effectiveness for colonoscopy outcomes. We prospectively assessed whether the implementation of a CQI program in routine clinical practice influences the quality performance of colonoscopy.
  
  
  METHODS
  In an open-access endoscopy unit at a secondary care center in Northern Italy, 6-monthly audit cycles were carried out over a 4-year period, to identify reasons for poor colonoscopy outcomes and institute appropriate changes to improve performance. The colonoscopy completion rate and the polyp detection rate as detected by endoscopists were considered to be key measures for improvement.
  
  
  RESULTS
  The initial crude colonoscopy completion rate was 84.6%, with a range for individual endoscopists 80.4%-94%. Four endoscopists had a completion rate lower than 90%. The overall polyp detection rate was 34%, with a wide variation among endoscopists (range 14%-42%). Poor patient tolerance and differences in colonoscopist expertise were the main determinants of lack of completion and variation in polyp detection rate. Changes to sedation practice, greater access to endoscopy sessions for the endoscopists with the lowest performance rates, and other organizational arrangements, were implemented to improve quality performance. The crude completion rates improved consistently, up to 93.1%, over the study period. This trend was confirmed even when adjusted completion rates were calculated. All endoscopists reached a crude completion rate of 90% or more and a polyp detection rate of over 20%. The introduction of CQI did not significantly change the overall incidence of procedure-related complications.
  
  
  CONCLUSIONS
  The effectiveness of colonoscopy can be improved by implementing a CQI program in routine colonoscopy practice.
authors.affiliation: Department of Gastroenterology, Valduce Hospital, Como, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Imperiali
authors.forename: G
authors.initials: G
authors.lastname: Minoli
authors.forename: G M
authors.initials: GM
authors.lastname: Meucci
authors.forename: G
authors.initials: G
authors.lastname: Spinzi
authors.forename: E
authors.initials: E
authors.lastname: Strocchi
authors.forename: V
authors.initials: V
authors.lastname: Terruzzi
authors.forename: F
authors.initials: F
authors.lastname: Radaelli
mesh_terms: D002983:Clinical Competence; D003111:Colonic Polyps / Q000175:diagnosis; D003113:Colonoscopy / Q000009:adverse effects / Q000592:standards*; D016292:Procedural Sedation; D003955:Diagnostic Tests, Routine / Q000592:standards; D004502:Education, Medical, Continuing; D006801:Humans; D007558:Italy; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D017749:Total Quality Management