Michelle Ganyo, MD, Lawson Robert, MD, Amanda Cimsit, MD. Naval Medical Center San Diego
INTRODUCTION: In 2015, the American Society of Gastrointestinal Endoscopy/American College of Gastroenterology Task Force on Quality in Endoscopy released updated guidelines on measuring quality in colonoscopy. This identified metrics and provided benchmark goals to serve as proxy measures for the quality of patient preparation and the performance of colonoscopy. The United States Navy (USN) has a program that seeks to maximize patient access to CRC screening services (i.e. HEDIS) but not a similarly well-established program to track quality of colonoscopy. The aim of this study is to review the initial outcomes of a newly-implemented colonoscopy quality initiative at a single tertiary Navy medical center.
METHODS AND MATERIALS: This was a retrospective study of all colonoscopy CRC screening exams of average risk patients performed from January 2016 – April 2017 at a single tertiary Navy training medical center. Endoscopists at the combined endoscopy center (CEC) included 5 gastroenterologists (GI) and 3 surgeons (GS). Quality metrics that were calculated and compared to national benchmarks included withdrawal time > 6 minutes, rate of ‘adequate’ bowel preparation (≥ 85%), cecal intubation rate (≥ 90%) and adenoma detection rate (ADR, ≥ 20% for females and ≥30% for males). These metrics were then individually presented to each endoscopist and evidence-based strategies for improvement were implemented. Additional hands-on training was provided for staff as indicated. A 3-month review after training was performed.
RESULTS: For all CEC endoscopists, 99% of patients had an ‘adequate’ bowel preparation, the overall cecal intubation rate was 97.8%, and 97% of exams had withdrawal times ≥ 6 minutes. The combined CEC average for ADR was 24% for females and 35% for males; however ADR for GI was 33% for females and 42% for males, while ADR for GS was lower and below benchmark standards at 18% and 25%, respectively. See Table 1 for ADR results.
CONCLUSIONS: To our knowledge this is the first systematic unit-based, colonoscopy quality initiative at a tertiary medical center in the USN. Worldwide the USN has 9 duty stations in which surgeons are the only endoscopist which could have serious implications regarding the quality of colonoscopy. When we report our 3-month data, we hope to demonstrate improvement in ADR for all CEC endoscopists, most notably GS. If successful, we propose to implement our method of endoscopic education and training program Navy-wide to ensure our active duty personnel and dependents receive quality colonoscopy that is on par with national standards.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86505
Program Number: MSS21
Presentation Session: Full-Day Military Surgical Symposium – General Surgery Presentations
Presentation Type: MSSPodium