Feasibility of Continuous Monitoring of Endoscopy Performance and Adverse Events: A Single-Center Experience

Abstract

Background: We integrated a standardized questionnaire focusing on adverse events and performance measures in gastrointestinal endoscopy as a mandatory component of the electronical medical record. Methods: This retrospective study was conducted using prospectively collected data on quality parameters and adverse events (AEPM) for all diagnostic and therapeutic endoscopic procedures at our center between 2018 and 2020. Results: A total of 7532 consecutive endoscopic procedures were performed in 5035 patients. The proportion of high-risk examinations and high-risk patients was 20% and 23%, respectively. Severe adverse events (AEs, n = 21) occurred in 0.3% of procedures and significantly more often in patients with an ASA score > II (0.6%, p < 0.01). We observed no long-term morbidity after severe AEs. Mortality was 0.03% (n = 2). Following screening colonoscopy (n = 242), four endoscopists documented AEPM in more than 98% of the examinations. The cecal intubation rate was 97%, and the mean adenoma detection rate 60%. The quality of lavage was documented in 97% (rated as good in 70% and moderate in 24%). Conclusions: The risk of adverse events is significantly increased in patients with an ASA score > II, which should be considered when choosing treatment methods and precautionary measures. Continuous recording of AEPM can be effectively integrated into the clinical reporting process, enabling analysis of the data and feedback to be provided to endoscopists.

How to implement adverse events as a quality indicator in gastrointestinal endoscopy

“…Attempts to improve the registration of AEs have been studied. Repetitive staff meetings help to increase awareness of the registration within the department and the hospital 16,55 . Patient questionnaires, either on paper or app‐based, to capture postprocedure AEs rely on patient collaboration and willingness to respond to the questions and to (digitally) send back the document.…”

“…Retrospective review of the medical files of all patients who underwent endoscopy by an independent external auditor was also shown very effective, but too labor intensive to be implemented in daily clinical practice 16,59 . Continuous prospective registration of AEs may be more efficient, provided rigorous follow‐up of all patients by the respective endoscopists up to 30 days postprocedure 55 . This monitoring system also needs external audits in order to maintain quality and completeness.…”

“…Repetitive staff meetings help to increase awareness of the registration within the department and the hospital. 16,55 Patient questionnaires, either on paper or app-based, to capture postprocedure AEs rely on patient collaboration and willingness to respond to the questions and to (digitally) send back the document. The return of these questionnaires is usually far from complete, and patients tend to experience symptoms from any underlying condition as possibly related to the recently undergone endoscopic procedure.…”

“…The return of these questionnaires is usually far from complete, and patients tend to experience symptoms from any underlying condition as possibly related to the recently undergone endoscopic procedure. 16,55,56 These patient questionnaires have a reliability issue. Therefore, systematic postprocedure patient contact by phone calls have been proposed, as a method to capture postprocedure AEs in a more complete and trustworthy manner.…”

“…54 The use of a (digital) template document including all aspects of endoscopic AEs to be recorded (Table 1) helps to improve awareness and registration of AEs in daily practice. 16,55 Intraprocedure AEs are easily captured, whereas intraprocedural incidents, both endoscopy-and anesthesia-related, are much less recorded. 16 The differential characteristics of AEs and incidents are not always welldefined, as previously explained.…”