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Continuous ADR50 monitoring through automated linkage between endoscopy and pathology: a quality improvement initiative in a Brussels public hospital

Ahead of print available from 04/02/2022
These articles are scheduled for publication in Vol. 85 (2) 2021

Author(s) G. Rasschaert 1 2, M. Gomez Galdon 3, J. Vandevelde 4, P. Eisendrath 1
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(1) Department of Gastroenterology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
(2) Department of Gastroenterology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
(3) Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
(4) Department of Information Technology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium

Background and study aim: Adenoma detection rate in patients aged 50 years or older (ADR50) is considered by the European Society of Gastrointestinal Endoscopy (ESGE) a key performance measures for lower gastrointestinal endoscopy. Technical and human resources constrain implementation of recording quality monitoring. The aim was to deploy an infrastructure for continuous monitoring of endoscopy quality indicators. And to evaluate its potential benefit on quality performance.

Methods: A company reporting system was adapted by adding a dedicated tab for quality monitoring, including: preparation, progression, number of resected polyps. Automated linkage with the pathology database resulted in continuous monitoring of inter alia: rate of adequate bowel preparation, cecal intubation rate and ADR50. Continuous monitoring was done for all nine endoscopists working at our center, with individual feedback after 4, 9 and 28 months.

Results: A total of 1434 colonoscopies were performed during the first 9 months of monitoring, 682 during the first 4 months, 752 during the following 5 months. Five months after feedback a global increase in ADR50 of 4.6% (22.9% to 27.5%) (P<0.05) was observed, compared to the first 4 months. Thus meeting the benchmark (=25%) recommended by ESGE. A durable effect of monitoring and feedback was observed after 28 months (ADR50: 29.4%).

Conclusions: An easy to use infrastructure for registration of quality monitoring in daily endoscopy practice, automatically linking the pathology database, facilitates continuous monitoring of endoscopy quality indicators. A global and durable ADR50 increase was observed after feedback, considered a quality improvement in performance of lower gastrointestinal endoscopy at our center.

Keywords: ADR50, automation, quality improvement, lower gastrointestinal endoscopy
The authors declare that they have no conflict of interest.
© Acta Gastro-Enterologica Belgica.