Paediatric Endoscopy Global Rating Scale

Abstract

Introduction: The endoscopy Global Rating Scale (GRS) is a web based self-assessment quality improvement tool providing a framework for service improvement. Widespread use of the GRS in adult endoscopy services in the United Kingdom (UK), has led to a demonstrable improvement in quality. The adult GRS is not directly applicable to paediatric endoscopy services. Objectives: To develop and pilot a paediatric endoscopy GRS (P-GRS) as a quality improvement tool. Methods: Members of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Endoscopy Working Group collaborated with the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) to develop the P-GRS. After a period of consultation this was piloted nationally in 9 centres and data was collected prospectively at two census points, May and December 2016. Results: The P-GRS mirrors the adult GRS by dividing care into four domains and includes 19 standards with several measures that underpin the standards. Eight services completed the online P-GRS return in May 2016 and six in December 2016. All pilot sites identified areas that needed improvement and post-pilot reflected on the key challenges and developments. Several positive developments were reported by the pilot sites. Conclusions: The national pilot helped ensure that the P-GRS developed was relevant to paediatric endoscopy services. The pilot demonstrated that even in the first year of engaging with this quality improvement tool, services were starting to identify areas that needed improvement, share best practice documents, put in place quality improvement plans and support greater patient involvement in services.

Pediatric endoscopy training across Europe: a survey of the ESPGHAN National Societies Network 2016–2019

“…Trainees should have up-to-date knowledge about the techniques available in relation to the relevant indications, risks, and benefits of such procedures. A current Endoscopy Training Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) is mandatory reading in this context 2 Training, technical skills, health services provided, facilities, staff availability, clinical quality and patient and caregiver experience are quality indicators for endoscopic procedures 3 4 5 6 7 8 that provide better health outcomes, better patient and caregiver experience and fewer repeat interventions 9 10 . The increasing frequency and variability of complex endoscopic procedures in children has led to the need for dedicated, child-friendly facilities equipped with advanced endoscopy equipment and experienced medical, nursing and administrative staff – a prerequisite for high-quality endoscopy services 11 .…”

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Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) is mandatory reading in this context [2] Training, technical skills, health services provided, facilities, staff availability, clinical quality and patient and caregiver experience are quality indicators for endoscopic procedures [3][4][5][6][7][8] that provide better health outcomes, better patient and caregiver experience and fewer repeat interventions [9,10]. The increasing frequency and variability of complex endoscopic procedures in children has led to

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Overview of the Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy

“…Measuring the quality of endoscopic care is an increasingly expected standard component of performing gastrointestinal endoscopy in children (1,2). Quality of care has been defined as the “degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (3).” With regard to endoscopy, quality of care is multifaceted and encompasses technical skill, as well as elements related to the healthcare system, facilities, workforce, training, clinical quality, and patient and caregiver experience (4–7). Although the pediatric endoscopy community has long endeavored to consistently provide the best possible patient care, it is currently underequipped to achieve this goal, in large part as pediatric-specific quality standards and indicators are lacking.…”

“…Since then, minimal quality standards for the delivery of endoscopy have been established (27,28) and the endoscopy Global Rating Scale (GRS), a web-based, patient-centered quality improvement tool for endoscopy units, has been developed for national use (36,37). More recently, an adapted GRS has been successfully piloted in pediatric units in the United Kingdom (7). In Canada, the Canadian Association of Gastroenterology (CAG) has published consensus guidelines on safety and quality in endoscopy, which include a comprehensive set of clearly defined, evidence-based measures to support continuous quality improvement in endoscopy across Canada (4).…”

Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy Facilities

“…H igh-quality endoscopic procedures in children require facilities that are specifically designed to assure best practice in pediatric populations (1)(2)(3). Generally speaking, there is a paucity of evidence to define best endoscopic practices for both children and adults, although a number of endoscopic societies have developed guidelines for the latter (4)(5)(6)(7)(8)(9). To ensure optimal performance of pediatric gastrointestinal procedures, facilities that support endoscopy services in children require evidence-and consensus-based standards and indicators that focus on safety and efficacy.…”