The "golden retriever" study: improving polyp retrieval rates by providing education and competitive feedback.
OBJECTIVE
Although optical diagnosis of small colorectal polyps can be achieved at expert centers, accurate prediction of histopathological outcomes has not been achieved in all practice settings. It is therefore important that resected polyps are retrieved for histology. The aims of this study were to evaluate the effect of education and competitive feedback on the overall polyp retrieval rate and to determine which polyp-related and procedure-related factors are associated with retrieval.


METHODS
We prospectively included consecutive colonoscopies performed at a single center between April 1, 2013 and April 1, 2014. Patients with inflammatory bowel disease or familial polyposis syndromes were excluded from analysis. Six months after the start of the study, all endoscopists were educated on the importance of polyp retrieval, and a competition was started by publicly providing feedback on the retrieval rate of all endoscopists and the monthly best 3 performers (or "golden retrievers") in particular. We compared overall retrieval rates in the 6 months before and after the start of the competition.


RESULTS
The overall polyp retrieval rate improved from 88% (525/594) to 93% (978/1047), comparing consecutive colonoscopies performed in the 6 months before and during the polyp retrieval competition (P < .01). The histopathological outcomes of retrieved polyps were not different before and during the competition. The retrieval rate of right-sided polyps increased from 85% to 95% during the competition (odds ratio [OR], 3.3; 95% confidence interval [CI], 2.0-5.4), whereas the left-sided retrieval rate remained 92%. On multivariable analysis, polyp size greater than 5 mm (OR, 4.1; 95% CI, 1.8-9.6) and in competition resection (OR, 1.8; 95% CI, 1.3-2.6) were significantly associated with polyp retrieval, respectively.


CONCLUSIONS
Providing education and competitive feedback to endoscopists will improve polyp retrieval rates, especially for clinically relevant, right-sided polyps.
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
Tim D G
TD
Belderbos
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Martijn G H
MG
van Oijen
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
Leon M G
LM
Moons
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
Peter D
PD
Siersema
D000236:Adenoma / Q000601:surgery; D018256:Adenomatous Polyps / Q000601:surgery*; D002277:Carcinoma / Q000601:surgery*; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005246:Feedback; D005257:Fellowships and Scholarships; D005762:Gastroenterology; D006801:Humans; D015999:Multivariate Analysis; D011446:Prospective Studies; D058996:Quality Improvement