title: A multicenter pragmatic study of an evidence-based intervention to improve adenoma detection: the Quality Improvement in Colonoscopy (QIC) study.
abstract: OBJECTIVE
  Low adenoma detection rates (ADRs) at colonoscopy are linked to significantly higher interval cancer rates, and vary between colonoscopists. Studies demonstrate that lesion detection is improved by: withdrawal time of ≥ 6 minutes; use of hyoscine butylbromide; position change; and rectal retroflexion. We evaluated the feasibility of implementing the above "bundle" of interventions into colonoscopy practice, and the effect on ADR.
  
  
  METHODS
  A longitudinal cohort design was used. Implementation combined central training, local promotion, and feedback. The uptake marker was change in hyoscine butylbromide use. Comparisons were between the 3 months before and the 9 months after the implementation phase, globally, by endoscopy unit and by quartile when colonoscopists were ranked according to baseline ADR. Chi-squared or Fisher's tests were used to evaluate significance.
  
  
  RESULTS
  12 units participated. Global and quartile analyses included data from 118 and 68 colonoscopists and 17 508 and 14 193 procedures respectively. A significant increase in hyoscine butylbromide use was observed globally (54.4 % vs. 15.8 %, P < 0.001), in all endoscopy units (P < 0.001) and quartiles (P < 0.001). A significant increase in ADR was observed globally (18.1 % vs. 16.0 %, P = 0.002) and in the lower two colonoscopist quartiles (P < 0.001), with a nonsignificant increase in the upper middle quartile and a significant fall to 21.5 %. in the upper quartile. The significant variations in ADR among the upper three quartiles disappeared.
  
  
  CONCLUSIONS
  In routine clinical practice, introduction of a simple, inexpensive, evidence-based "bundle" of measures is feasible and is associated with higher global ADR, driven by improvements amongst the poorest performing colonoscopists.
authors: South Tyneside District General Hospital, South Shields. UK.
authors: Praveen T
authors: PT
authors: Rajasekhar
authors: South Tyneside District General Hospital, South Shields. UK.
authors: Colin J
authors: CJ
authors: Rees
authors: Northern Region Endoscopy Group, South Shields. UK.
authors: Mike G
authors: MG
authors: Bramble
authors: School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.
authors: Douglas W
authors: DW
authors: Wilson
authors: Northern Region Endoscopy Group, South Shields. UK.
authors: Matthew D
authors: MD
authors: Rutter
authors: St Mark's Hospital, Northwick Park, Harrow, UK.
authors: Brian P
authors: BP
authors: Saunders
authors: School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.
authors: A Pali S
authors: AP
authors: Hungin
authors: Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors: James E
authors: JE
authors: East
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D002086:Butylscopolammonium Bromide / Q000008:administration & dosage*; D003113:Colonoscopy / Q000193:education / Q000379:methods / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D058996:Quality Improvement; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D002086:Butylscopolammonium Bromide