Establishing a quality indicator format for endoscopic ultrasound

Abstract

AIM:To perform a quality control (QC) review of endoscopic ultrasound (EUS) with emphasis on current consensus established quality indicators. METHODS:A national quality control study of EUS was performed with expanded international comparison. Ten different healthcare institutions in Israel participated in coordination with University of Chicago Medical Center. Each Israeli center provided ten patient reports, compared with twenty reports from University of Chicago Medical Center. Quality indicator forms were prepared with sections to be completed before, during, and after EUS. Physician compliance to all listed indicators was evaluated. Quality indicators were evaluated prior to, during, and after performing EUS. RESULTS:One hundred different EUS procedural reports were analyzed. The mean patient age was 59 years old. Indications for referral were mostly for pancreatic or biliary reasons. QC showed several strongly reported areas, including indications for EUS (97%), anesthesia given (94%), periprocedural pancreatic evaluation (87%), and an overall summary of the EUS examination (82%). Intermediately reported areas included patients' pertinent past medical history (71.7%), evaluation of the biliary tree (63%), and providing medical guidance about potential procedural adverse events, including pancreatitis and bleeding (52%). Half of the reports (50%) did not include a systemic organ evaluation. Other areas, including systematic reporting of screened organs (36%), description of fine needle aspiration (15%), tumor description via tumor-nodemetastasis (5%), and listing of adverse events (0%) were largely lacking from procedural documentation. CONCLUSION:Documenting specific EUS quality indicators including listing post-procedural recommendations may improve the quality and efficiency of future EUS examinations and subsequent patient follow-up.© 2013 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Endoscopic ultrasound; Quality indicators; Quality control; Fine needle aspiration; Malignancy Core tip: Certain key points of quality control have been delineated as quality indicators by American and European Gastrointestinal Societies, which serve to establish and maintain high-quality gastrointestinal minimally invasive procedures and reports, minimize potential adverse events, and to optimize costs, resulting in savings for both hospitals and patients while optimizing patient care in the process. This national quality control study of endoscopic ultrasound (EUS) with expanded international comparison emphasized developing a

How to measure quality in endoscopic ultrasound

“…Likewise, Coe et al found endoscopist adherence to EUS QIs over an eight-year span to be strictly related to significant improvement in all EUS aspects (15). Lachter et al explored adherence to EUS QIs at ten different Israeli medical centers keeping as standard the University of Chicago and observed that an overall improvement in documented quality of EUS exams was found in centers ensuring comprehensive documentation and stronger guideline adherence (16). Further confirm of these findings was provided in the study by Schwab et al, where significant improvements were demonstrated in QI adherence and thus EUS reporting and delivery quality in 2013-2014 reports as compared to 2009 results (17).…”

“…Therefore, authors concluded that QI implementation facilitates effective high-quality EUS exams by ensuring comprehensive documentation while limiting error (17). However, adherence to quality guidelines remains still jeopardized across several centers, with some items such as description of FNA, or listing of adverse events largely lacking from procedural documentation (16).…”

Basic technique in endoscopic ultrasound-guided fine needle aspiration for solid lesions: What needle is the best?

“…[ 18 ] In one survey at a Chicago EUS for experts seminar, 75% of echoendoscopists reported using the stylet when putting in the needle and 25% have taken to removing it. [ 19 ] No study which clearly examined the head-to-head benefits to risks of rounded/ball-tip stylets to beveled stylets for EUS-FNA has appeared.…”

Quality of reporting in endoscopic ultrasound: Results of an international multicenter survey (the QUOREUS study)

“…Unlike digestive endoscopy, the quality of reporting in endoscopic ultrasound (EUS) has not been thoroughly evaluated and a reference standard is lacking 13 14 15 16 17 . EUS is a complex technique with several diagnostic and therapeutic applications 18 19 20 21 22 23 24 .…”