Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopists and Endoscopists in Training

Abstract

Introduction: High-quality pediatric endoscopy requires reliable performance of procedures by competent individual providers who consistently uphold all standards determined to assure optimal patient outcomes. Establishing consensus expectations for ongoing monitoring and assessment of individual pediatric endoscopists is a method for confirming the highest possible quality of care for such procedures worldwide. We aim to provide guidance to define and measure quality of endoscopic care for children. 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 endoscopists. Consensus was sought via an iterative online Delphi process and finalized at an in-person conference. 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 6 standards that all providers who perform pediatric endoscopy should uphold and 2 standards for pediatric endoscopists in training, with 7 corresponding indicators that can be used to identify high-quality endoscopists. Additionally, these can inform continuous quality improvement at the provider level. Minimum targets for defining high-quality pediatric ileocolonoscopy were set for 2 key indicators: cecal intubation rate (!90%) and terminal ileal intubation rate (!85%). Discussion: It is recommended that all individual providers performing or training to perform pediatric endoscopy initiate and engage with these international endoscopist-related standards and indicators developed by PEnQuIN.

Characterization of Colonoscopies in Preschool Children

“…A strength of our study is that we evaluated a large number of children including preschoolers undergoing colonoscopy. Our rate of adequate bowel preparation was also higher than the ≥80% proposed by the PEnQuIN working group as a key indicator for high‐quality colonoscopic procedure (4). Another strength in this study is the objective confirmation of extent of procedure rather than just relying on the endoscopist’s report, in contrast to previous studies which have not reported on this.…”

“…In recent years, attempts have been made to define quality indicators (QI) in pediatric colonoscopy (3). A joint North American and European initiative, Pediatric Endoscopic Quality Improvement Network (PEnQuIN), recommended ≥85% ileal intubation and ≥90% cecal intubation rates as quality standards in pediatric colonoscopy (4). Whether this is achievable in very young children, especially those aged less than 6 years, is unclear.…”

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

“…A fourth domain included in the GRS, entitled “Training,” was determined to be outside the scope of this document, which applies to all facilities, regardless of the presence or absence of trainees. Standards and indicators that relate to training are included in an independent PEnQuIN consensus guideline that addresses endoscopist considerations, including training (25).…”

“…Standards and indicators that relate to training are included in an independent PEnQuIN consensus guideline that addresses endoscopist considerations, including training (25). Each standard that reached consensus for inclusion in this PEnQuIN guideline on facility quality is presented below, with the strength of recommendation and quality of supporting evidence (according to the GRADE approach), a short discussion of the evidence considered and the voting results.…”

Harnessing Electronic Medical Record Tools to Provide Proceduralist Feedback on Pediatric Endoscopy Quality Metrics

“…A related benefit is the ability to ensure meeting of quality standards for colonoscopy. PEnQuIN has recommended that 90% cecal intubation rates and 85% terminal ileum intubation rates be maintained over time (11). As a group, we have consistently met these standards since inception of our data dashboard and will continue to monitor group performance to ensure maintained compliance with these standards.…”