Colonoscopists and Rates of Procedures Per Year
Colonoscopists and Rates of Procedures Per Year
When plotting individuals' volume per annum against their CIR and when plotting groups of individuals who have undertaken a similar volume per annum (groups of 50), the trend-line on both charts (Figures 1 and 2) crosses a 90% CIR at a volume of 120–125 procedures. The subanalysis focuses on individuals undertaking between 20 and 199 procedures per annum. Individuals were grouped with others undertaking a similar volume per annum (groups of 20 and groups of 10). Plotting these data against CIR, the trend-line on both charts (Figures 3 and 4) crosses a 90% CIR at a volume of 110–120 procedures per annum.
While there will be variance in the quality of colonoscopy provided by individuals, the relationship with larger volume per annum and improved quality is intuitive—'practice makes perfect'. This detailed analysis of such a large number of colonoscopies (12 594 in 2 years) suggests that JAG should advise operators to undertake a minimum of 120 procedures per annum to assist in attaining a minimum CIR standard of 90%.
Is this a feasible target? We believe strongly that it is. Most full time operators will be endoscoping at least 40 weeks per calendar year (allowances for annual leave, study leave and on-call commitments). A total of 120 colonoscopies for an operator endoscoping 40 weeks per annum is equivalent to three colonoscopies per week. An operator doing one list per week should be able to do three colonoscopies on that list, and those undertaking two or more lists per week should be able to achieve this with ease.
We believe strongly that a minimum standard of 120 colonoscopies per annum will have a positive effect on service and training. We would suggest that units flex capacity in order to achieve this. Lists should be profiled to operators' capabilities concentrating more colonoscopies in fewer operators to preserve the volume and associated improved outcomes. Consolidating the number of operators performing more colonoscopies with improved outcomes will potentially translate into an enhanced training experience and skills translation.
Of real concern are operators carrying out less than 100 procedures per year; they did not meet the desired CIR quality standard, and performed 4793 colonoscopies. We would suggest that this reflects a wider experience in the English health service and needs to be addressed. It would be of great value and insight to triangulate this performance against a range of quality standards for colonoscopy.
In conclusion, this analysis of 12 594 colonoscopies over 2 years, namely, 129 operators doing between 20 and 399 colonoscopies per annum, suggests that to attain a minimum CIR of 90% operators should undertake at least 120 colonoscopies per annum. For most operators, this is equivalent to three colonoscopies per week—which is possible if one list per week is undertaken. For those undertaking two or more lists then this is achievable with ease. Endoscopy units need to reflect on this and consolidate operators to preserve volume and the associated improved outcomes. This will benefit patients, service and training.
We recommend a minimum volume of 120 colonoscopies be performed per year in order to meet current quality standards, and this should be reflected in JAG guidance.
Discussion
When plotting individuals' volume per annum against their CIR and when plotting groups of individuals who have undertaken a similar volume per annum (groups of 50), the trend-line on both charts (Figures 1 and 2) crosses a 90% CIR at a volume of 120–125 procedures. The subanalysis focuses on individuals undertaking between 20 and 199 procedures per annum. Individuals were grouped with others undertaking a similar volume per annum (groups of 20 and groups of 10). Plotting these data against CIR, the trend-line on both charts (Figures 3 and 4) crosses a 90% CIR at a volume of 110–120 procedures per annum.
While there will be variance in the quality of colonoscopy provided by individuals, the relationship with larger volume per annum and improved quality is intuitive—'practice makes perfect'. This detailed analysis of such a large number of colonoscopies (12 594 in 2 years) suggests that JAG should advise operators to undertake a minimum of 120 procedures per annum to assist in attaining a minimum CIR standard of 90%.
Is this a feasible target? We believe strongly that it is. Most full time operators will be endoscoping at least 40 weeks per calendar year (allowances for annual leave, study leave and on-call commitments). A total of 120 colonoscopies for an operator endoscoping 40 weeks per annum is equivalent to three colonoscopies per week. An operator doing one list per week should be able to do three colonoscopies on that list, and those undertaking two or more lists per week should be able to achieve this with ease.
We believe strongly that a minimum standard of 120 colonoscopies per annum will have a positive effect on service and training. We would suggest that units flex capacity in order to achieve this. Lists should be profiled to operators' capabilities concentrating more colonoscopies in fewer operators to preserve the volume and associated improved outcomes. Consolidating the number of operators performing more colonoscopies with improved outcomes will potentially translate into an enhanced training experience and skills translation.
Of real concern are operators carrying out less than 100 procedures per year; they did not meet the desired CIR quality standard, and performed 4793 colonoscopies. We would suggest that this reflects a wider experience in the English health service and needs to be addressed. It would be of great value and insight to triangulate this performance against a range of quality standards for colonoscopy.
In conclusion, this analysis of 12 594 colonoscopies over 2 years, namely, 129 operators doing between 20 and 399 colonoscopies per annum, suggests that to attain a minimum CIR of 90% operators should undertake at least 120 colonoscopies per annum. For most operators, this is equivalent to three colonoscopies per week—which is possible if one list per week is undertaken. For those undertaking two or more lists then this is achievable with ease. Endoscopy units need to reflect on this and consolidate operators to preserve volume and the associated improved outcomes. This will benefit patients, service and training.
We recommend a minimum volume of 120 colonoscopies be performed per year in order to meet current quality standards, and this should be reflected in JAG guidance.
Source...