Gastroenterological Endoscopy. Группа авторов
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Название: Gastroenterological Endoscopy

Автор: Группа авторов

Издательство: Ingram

Жанр: Медицина

Серия:

isbn: 9783131470133

isbn:

СКАЧАТЬ and incompetent endoscopists. Nevertheless, its global introduction, particularly for endoscopists who are currently practicing independently, is controversial. Many services have compromised by introducing accreditation only for newly-trained endoscopists, anticipating that, within a generation, all independently practicing endoscopists will have been accredited at inception.

      When potential underperformance is identified by measuring PMs, it is important that further analysis and action is handled in a supportive and constructive manner. Many organizations have developed well-defined, open, structured processes for managing underperformance,29 and when handled sensitively, experience shows that most endoscopists embrace such support. However, this is not universal and on occasions there may be resistance to engagement with such processes from individuals or even from services. This may be driven by embarrassment or fear that one’s abilities might be demonstrated to be suboptimal, and may be pronounced if there are financial or service drivers to continue with the status quo. Nevertheless, it is essential for high-quality patient care that these barriers are overcome.

      Unfortunately, trials of initiatives to improve specific aspects of endoscopic quality have not been universally successful. For example, evidence reveals that endoscopists who spend more time inspecting the colonic mucosa find more pathology11; however, initiatives to mandate a minimum withdrawal time have produced mixed results.30,31,32 We should not use this as evidence to give up on quality improvement though—these studies further our understanding of the techniques that underpin high-quality endoscopy, allowing us to refine training methodology. Moreover, such direct interventions are only one component of quality improvement—more global quality improvement initiatives have been highly successful: for example, in the United Kingdom, introducing PMs along with additional measures such as structured training programs resulted in significant improvement in endoscopy quality, where cecal intubation rate improved from 76.9 to 92.3%.18

      Fig. 9.5 An example of automated endoscopy training data from the UK JETS training scheme.

      9.5 Summary

      Quality in endoscopy is essential to maximize the benefit and minimize potential harm from these common, invasive procedures. The potential benefit to public health from improving endoscopy quality is large. Despite half a century having passed since the advent of flexible endoscopy, embedding QA and quality improvement into everyday endoscopic practice remains very much in its infancy. PMs are being developed for all aspects of clinical care. The importance of objective, standardized, and automated processes, mandated and coordinated at a regional or national level, is increasingly recognized. There remains, however, a need to prioritize research to strengthen the evidence base for quality metrics and effective quality improvement initiatives.

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