• David Armstrong, Alan Barkun, Ron Bridges, Rose Carter, Chris de Gara, Catherine Dube, Robert Enns, Roger Hollingworth, Donald Macintosh, Mark Borgaonkar, Sylviane Forget, Grigorios Leontiadis, Jonathan Meddings, Peter Cotton, Ernst J Kuipers, and Canadian Association of Gastroenterology Safety and Quality Indicators in Endoscopy Consensus Group.
• Division of Gastroenterrology, McMaster University, Hamilton, Ontario, Canada. armstro@mcmaster.ca
• Can. J. Gastroenterol. 2012 Jan 1;26(1):17-31.

BackgroundIncreasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy.ObjectiveTo identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery.MethodsA multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants.ResultsConsensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified.DiscussionThe consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services.ConclusionsThe guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy.

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