Colonoscopists and Rates of Procedures Per Year
Colonoscopists and Rates of Procedures Per Year
Introduction. The measurement of the quality of colonoscopy has been in the vanguard of quality improvement. The Joint Advisory Group on Gastrointestinal endoscopy (JAG) has issued guidance for practitioners to achieve caecal intubation rates (CIR) of ≥90% and to undertake ≥100 colonoscopies per annum. The British Society of Gastroenterology National Colonoscopy Audit published in 2012–2013 demonstrated a combined CIR of 92.3%. In 2012, we published data from 16 064 colonoscopies showing a combined CIR of 90.57%—both meeting JAG's standard. Analysis of our audit looked at the relationship of volume and outcome. CIR of operators performing ≥100 procedures per annum was 91.76%; those performing <100 was 87.77%. The 2-year data we collected involved 120+ operators. This provided an opportunity to study the correlation between volume and CIR in detail.
Methods. We analysed 129 operator records who had undertaken 20–399 procedures per annum (total 12,594). Each operator's volume was plotted against CIR as individuals and groups of operators undertaking a similar annual volume. 9859 procedures (78.3%) were performed by operators undertaking 20–199 procedures per annum (120 operators); this subgroup was further analysed.
Results When plotting individuals and groups of individuals who have undertaken a similar annual volume against CIR, the trend-lines cross a 90% CIR at a volume of 120–125 procedures. The subgroup analysis showed the trend-line crossing at 110–120 procedures.
Conclusions This detailed analysis of 12,594 colonoscopies over 2 years suggests that JAG should advise operators to undertake ≥120 procedures per annum to support the quality standard for CIR of ≥90%.
The measurement of quality of colonoscopy has been in the vanguard of quality improvement, with two large UK based audits describing key performance standards. The Joint Advisory Group on Gastrointestinal endoscopy (JAG), an inter-collegiate body responsible for standards, quality and training, has issued guidance for caecal intubation rates (CIR) of 90% or higher on an intention-to-colonoscope basis. They also advise that practitioners should undertake at least 100 colonoscopies per annum. The published audits have compared the data collected with these standards.
In February 2011, the British Society of Gastroenterology undertook a prospective National Colonoscopy Audit to assess quality standards, which included metrics such as CIR, sedation practice, comfort scores, perforation rate and adenoma detection rate. It looked at over 20 085 procedures across the UK over a 2-week period. The study published in 2012–2013 demonstrated an overall CIR of 92.3% meeting JAG's standard.
In May 2012, we published data from 16 064 colonoscopies—a multi-centre retrospective audit of practice from a 2-year period, 2008–2009, showing a total CIR of 90.57%, also meeting JAG's standard.
Analysis of this audit looked at the relationship of volume and outcome. We compared combined CIR of operators meeting JAG's guidance of performing 100 or more procedures per annum (91.76%) against those performing fewer than 100 procedures per annum (CIR 87.77%). The gap in performance against this key standard was not surprising as the relationship of volume to quality and outcomes is well established, and has been used in England as the basis to reorganise vascular services and other complex specialities over the past few years.
The detailed data we have collected from a 2-year period involved over 120 operators. This provided an opportunity to study the correlation between volume of practice and CIR. We were therefore able to test JAG's standards and guide operators appropriately on volumes of colonoscopies an operator should aim to undertake per annum in order to ensure quality standards are maintained.
Abstract and Introduction
Abstract
Introduction. The measurement of the quality of colonoscopy has been in the vanguard of quality improvement. The Joint Advisory Group on Gastrointestinal endoscopy (JAG) has issued guidance for practitioners to achieve caecal intubation rates (CIR) of ≥90% and to undertake ≥100 colonoscopies per annum. The British Society of Gastroenterology National Colonoscopy Audit published in 2012–2013 demonstrated a combined CIR of 92.3%. In 2012, we published data from 16 064 colonoscopies showing a combined CIR of 90.57%—both meeting JAG's standard. Analysis of our audit looked at the relationship of volume and outcome. CIR of operators performing ≥100 procedures per annum was 91.76%; those performing <100 was 87.77%. The 2-year data we collected involved 120+ operators. This provided an opportunity to study the correlation between volume and CIR in detail.
Methods. We analysed 129 operator records who had undertaken 20–399 procedures per annum (total 12,594). Each operator's volume was plotted against CIR as individuals and groups of operators undertaking a similar annual volume. 9859 procedures (78.3%) were performed by operators undertaking 20–199 procedures per annum (120 operators); this subgroup was further analysed.
Results When plotting individuals and groups of individuals who have undertaken a similar annual volume against CIR, the trend-lines cross a 90% CIR at a volume of 120–125 procedures. The subgroup analysis showed the trend-line crossing at 110–120 procedures.
Conclusions This detailed analysis of 12,594 colonoscopies over 2 years suggests that JAG should advise operators to undertake ≥120 procedures per annum to support the quality standard for CIR of ≥90%.
Introduction
The measurement of quality of colonoscopy has been in the vanguard of quality improvement, with two large UK based audits describing key performance standards. The Joint Advisory Group on Gastrointestinal endoscopy (JAG), an inter-collegiate body responsible for standards, quality and training, has issued guidance for caecal intubation rates (CIR) of 90% or higher on an intention-to-colonoscope basis. They also advise that practitioners should undertake at least 100 colonoscopies per annum. The published audits have compared the data collected with these standards.
In February 2011, the British Society of Gastroenterology undertook a prospective National Colonoscopy Audit to assess quality standards, which included metrics such as CIR, sedation practice, comfort scores, perforation rate and adenoma detection rate. It looked at over 20 085 procedures across the UK over a 2-week period. The study published in 2012–2013 demonstrated an overall CIR of 92.3% meeting JAG's standard.
In May 2012, we published data from 16 064 colonoscopies—a multi-centre retrospective audit of practice from a 2-year period, 2008–2009, showing a total CIR of 90.57%, also meeting JAG's standard.
Analysis of this audit looked at the relationship of volume and outcome. We compared combined CIR of operators meeting JAG's guidance of performing 100 or more procedures per annum (91.76%) against those performing fewer than 100 procedures per annum (CIR 87.77%). The gap in performance against this key standard was not surprising as the relationship of volume to quality and outcomes is well established, and has been used in England as the basis to reorganise vascular services and other complex specialities over the past few years.
The detailed data we have collected from a 2-year period involved over 120 operators. This provided an opportunity to study the correlation between volume of practice and CIR. We were therefore able to test JAG's standards and guide operators appropriately on volumes of colonoscopies an operator should aim to undertake per annum in order to ensure quality standards are maintained.
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