How do you measure performance as a colonoscopist?
OBJECTIVE
The aim of this study was to describe an easy and reproducible method of measuring clinical performance in colonoscopy.


METHODS
Data from all endoscopy procedures performed within the main endoscopy unit at Derriford Hospital between January and December 2007 were analysed. Points were allocated for given procedures. A local health economic analysis revealed that at least 8 points (or four colonoscopies) must be performed to meet list costs. The clinical performance was described as a capability index of crude Caecal Intubation Rate (CIR) vs the mean Points Performed/Endoscopy List (points/list).


RESULTS
Overall, 3884 colonoscopies were performed, with a mean crude CIR of 89.6% and 8.3 points/List. Only 7/23 endoscopists consistently met the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) standard in a cost-effective way. An annual colonoscopy rate of ≥ 150 cases was associated with higher points per list (points/list) (P = 0.003). Endoscopists offering ≥ 15% of cases as training cases had significantly higher crude CIRs and points/list (P = 0.051; P = 0.017).


CONCLUSIONS
Clinical performance is a function of quality provided in a cost-effective way. Our capability index is an effective and reproducible way of measuring clinical performance. Training was not associated with reduced volume.
Gastrointestinal Directorate, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK. chrischalland@hotmail.com
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Hosie
D002983:Clinical Competence / Q000592:standards*; D003113:Colonoscopy / Q000191:economics* / Q000193:education / Q000592:standards*; D003362:Cost-Benefit Analysis / Q000379:methods; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017410:Practice Guidelines as Topic