Canadian Association of Gastroenterology consensus guidelines on safety and quality indicators in endoscopy.
BACKGROUND
Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy.


OBJECTIVE
To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery.


METHODS
A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants.


RESULTS
Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified.


CONCLUSIONS
The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services.


CONCLUSIONS
The guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy.
Division of Gastroenterrology, McMaster University, Hamilton, Ontario, Canada. armstro@mcmaster.ca
David
D
Armstrong
Alan
A
Barkun
Ron
R
Bridges
Rose
R
Carter
Chris
C
de Gara
Catherine
C
Dube
Robert
R
Enns
Roger
R
Hollingworth
Donald
D
Macintosh
Mark
M
Borgaonkar
Sylviane
S
Forget
Grigorios
G
Leontiadis
Jonathan
J
Meddings
Peter
P
Cotton
Ernst J
EJ
Kuipers
D000554:Ambulatory Care Facilities / Q000592:standards; D002170:Canada; D002983:Clinical Competence / Q000592:standards; D016099:Endoscopy, Gastrointestinal / Q000193:education / Q000592:standards*; D006801:Humans; D007258:Informed Consent / Q000592:standards; D010351:Patient Discharge / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards*