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PWE-065 Colonoscopy Performance In A District General Hospital. Has The Standardisation Of Training Standardised Performance?
  1. TM El Menabawey,
  2. J O’Donohue,
  3. R Srirajaskanthan
  1. Gastroenterology, University Hospital Lewisham, London, UK

Abstract

Introduction Since the introduction of the JAG endoscopy training system (JETS) for trainees in 2003 there have been demonstrable improvements in the key performance indicators (KPIs) of colonoscopy performance. Caecal intubation, polyp detection and polyp retrieval rates are audited KPIs for departments. Terminal ileum (TI) intubation rates are also recorded. The national colonoscopy audit has shown a disparity between medical and surgical performance, but little has been studied to assess if this has improved over time.

Methods We retrospectively audited these KPIs between 2004 and 2012, analysing for variations in performance for all colonoscopists encompassing both trainees and Consultants. We compared the performance of medics and surgeons for each year, the performance in 2004 with 2012 and the overall performance for 9 years using the Chi-squared test.

Results 10055 colonoscopies were performed over 9 years: 8938 by medics and 1117 by surgeons. Completion rates improved significantly from 2004 to 2012 for all colonoscopists (80.3 to 92.0%, p < 0.001). A significant improvement in both specialties’ completion rates was seen (medics: 84.1 to 93.0%, surgeons: 74.8 to 88.5%, p < 0.001). Over 9 years the overall completion rate for medics was higher (90.2 vs. 86.0%, p < 0.001). Between 2007 and 2011 there was no significant difference in completion rates. Both specialties’ TI intubation rate improved between 2004 and 2012 (medics: 46.3 to 64.1%, surgeons: 10.41 to 42.0%, p < 0.001). Overall surgeons were better at polyp detection (28.5 vs. 24.8%, p < 0.001). Surgical performance has not improved since 2004 (29.02 to 23.2% in 2012), whereas medics improved from 14.4 to 29.7% (p < 0.001) to a standard in line with surgical colleagues. Over 9 years there was no significant difference in polyp retrieval rates between specialties (74.9 vs. 76.7% respectively, p = 0.3) and the performance of both improved from 2004 to 2012 (medics: 44.2 to 90.9%, surgeons: 57.6 to 80.2%, p < 0.001).

Conclusion There has been an overall improvement in colonoscopists’ performance in all KPIs between 2004 and 2012. When performance is sub-divided into specialties, one can see that there were significant discrepancies in performance between physicians and surgeons in 2004. With the exception of TI intubation, performance has converged to a similar and higher standard in 2012. This coincides with the introduction of JETS and suggests standardised training may have served to normalise and improve the standard of colonoscopy across both specialties.

References Gavin DR et al. The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK. Gut 2012

Kelly NM, et al. Is the ‘driving test’ a robust quality indicator of colonoscopy performanceaWorld J Gastrointest Endosc 2010

Disclosure of Interest None Declared.

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