Sustained colonoscopy quality improvement using a simple intervention bundle

Abstract

Background Unacceptable variation in colonoscopy quality exists. The Quality Improvement in Colonoscopy (QIC) study in 2011 improved quality by introducing an evidence-based “bundle” of measures into routine colonoscopy practice. The QIC bundle included: minimal cecal withdrawal time of ≥ 6 minutes; hyoscine butylbromide use; supine patient position for transverse colon examination; rectal retroflexion. Colonoscopy quality was measured by adenoma detection rate (ADR). The current study measured whether these effects led to a sustained change in practice 3 years following implementation. Methods This observational study collected data from eight hospital trusts (sites) in the United Kingdom for a 6-month period, 3 years following QIC bundle implementation. Use of the antispasmodic, hyoscine butylbromide, was measured as a marker of bundle uptake. Bundle effectiveness was measured by ADR change. Comparisons were made between data before and immediately after implementation of the bundle. Results 28 615 colonoscopies by 188 colonoscopists were studied. Hyoscine butylbromide use increased from 15.8 % pre-implementation to 47.4 % in the sustainability phase (P < 0.01) indicating sustained engagement with QIC measures. ADR was higher in the sustainability period compared with pre-intervention, but only reached statistical significance among the poorest-performing colonoscopists. Conclusions The introduction of a simple, inexpensive, pragmatic intervention significantly changed practice over a sustained period, improving colonoscopy quality as measured by ADR, particularly in poorer performers. QIC demonstrates that an easy-to-implement quality improvement approach can deliver a sustained change in practice for many years post intervention.

Simple feedback of colonoscopy performance improved the number of adenomas per colonoscopy and serrated polyp detection rate

“…Endoscopy training improved the ADR 10 11 12 13 , mean number of adenomas per procedure (MAP) 14 , sessile serrated lesion (SSL) detection rate 15 , and proximal SP detection rate 16 . Lam et al reported that colonoscopy training improved interval CRC rates from 0.15 % to 0.08 % and early interval CRC rates from 0.07 % to 0.04 % 17 .…”

Implementation of an intervention bundle leads to quality improvement in ulcerative colitis endoscopy reporting

“…There is evidence for sustained improvement in adenoma detection rate after implementation of a simple quality improvement bundle for colonoscopy, which persisted for several years after implementation, especially amongst the poorest performing endoscopists. 12 Despite the evident advantages of high-quality endoscopy reporting and use of a scoring system in UC, there is a relative paucity of studies designed to investigate reporting quality and use of endoscopic indices in clinical practice. To address this, we conducted a multicentre study, carried out over two phases, that aimed to assess baseline reporting quality and evaluate the impact of a set of interventions (a bundle) designed at standardising and optimising reporting.…”

“…A “bundle” in this context offers a structured way of improving healthcare processes and involves a small, straightforward set of practices (generally three to five) that, when performed collectively and reliably, can improve outcomes. There is evidence for sustained improvement in adenoma detection rate after implementation of a simple quality improvement bundle for colonoscopy, which persisted for several years after implementation, especially amongst the poorest performing endoscopists 12 …”

Artificial intelligence for colonoscopic polyp detection: High performance versus human nature

“…Feedback with quality assurance data has been shown to modify ADR and the associated PCCR rates, but this is challenging to deliver at scale 3 . More straightforward educational interventions “evidence bundles” can also improve ADR with durable effects especially for poor performers 4 . Devices can also modify ADR, such as wider‐angle instruments, advanced endoscopic imaging, or caps and cuffs, though there are no data yet that this links to reduced PCCRC 5 …”