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

Abstract

Introduction:There is increasing international recognition of the impact of variability in endoscopy facilities on procedural quality and outcomes. There is also growing precedent for assessing the quality of endoscopy facilities at regional and national levels by using standardized rating scales to identify opportunities for improvement.Methods:With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of facilities where endoscopic care is provided to children. Consensus was reached via an iterative online Delphi process and subsequent in-person meeting. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach.Results:The PEnQuIN working group achieved consensus on 27 standards for facilities supporting pediatric endoscopy, as well 10 indicators that can be used to identify high-quality endoscopic care in children. These standards were subcategorized into three subdomains: Quality of Clinical Operations (15 standards, 5 indicators); Patient and Caregiver Experience (9 standards, 5 indicators); and Workforce (3 standards).Discussion:The rigorous PEnQuIN process successfully yielded standards and indicators that can be used to universally guide and measure high-quality facilities for procedures around the world where endoscopy is performed in children. It also underscores the current paucity of evidence for pediatric endoscopic care processes, and the need for research into this clinical area.

Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopic Procedures

“…All standards and indicators that were ascribed to procedural quality can be characterized as process measures that assess performance during the delivery of care (eg, proportion of children with suspected eosinophilic esophagitis who have esophageal biopsies obtained from multiple levels of the esophagus; proportion of patients and their caregivers who receive postprocedure instructions upon discharge). These are different from structural indicators, which measure quality of a healthcare environment (eg, availability of size appropriate equipment) and are delineated by the PEnQuIN working group in a separate document on pediatric endoscopy facilities (114).…”

Coronavirus disease 2019 and gastrointestinal disorders in children

“…The pandemic has had repercussions on digestive endoscopy in adults, 145 but even more so in children, where for safety and comfort concerns, endoscopy is recommended to be performed under general anesthesia or deep sedation. 167 Because the pandemic consumed almost all anesthetic support on a worldwide scale, pediatric gastroenterologists had to adapt to a clinical praxis with a significantly reduced capacity to perform endoscopic procedures essential to the assessment, treatment, and care of children with many GI conditions (e.g., CeD, eosinophilic esophagitis, and IBD). 168 To counter the effects of reduced endoscopy capacity, pediatric papers suggested temporary reductions in required immunoglobulin A anti-tissue transglutaminase antibody thresholds for nonbiopsy-verified CeD diagnoses.…”