Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopic Procedures

Abstract

Introduction: High-quality pediatric gastrointestinal procedures are performed when clinically indicated and defined by their successful performance by skilled providers in a safe, comfortable, child-oriented, and expeditious manner. The process of pediatric endoscopy begins when a plan to perform the procedure is first made and ends when all appropriate patient follow-up has occurred. Procedure-related standards and indicators developed to date for endoscopy in adults emphasize cancer screening and are thus unsuitable for pediatric medicine. Methods: With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of endoscopic procedures. Consensus was sought via an iterative online Delphi process and finalized at an in-person conference. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. Results: The PEnQuIN working group achieved consensus on 14 standards for pediatric endoscopic procedures, as well as 30 indicators that can be used to identify high-quality procedures. These were subcategorized into three subdomains: Preprocedural (3 standards, 7 indicators), Intraprocedural (8 standards, 18 indicators), and Postprocedural (3 standards, 5 indicators). A minimum target for the key indicator, ''rate of adequate bowel preparation,'' was set at !80%. Discussion: It is recommended that all facilities and individual providers performing pediatric endoscopy worldwide initiate and engage with the procedure-related standards and indicators developed by PEnQuIN to identify gaps in quality and drive improvement.

Harnessing Electronic Medical Record Tools to Provide Proceduralist Feedback on Pediatric Endoscopy Quality Metrics

“…We have already identified a common issue that needs improvement. The PEnQuIN working group has stipulated that 80% of bowel preps should meet adequacy standards (Boston bowel preparation score of 6 or greater) (1). Currently, over the past 6 months, only 63%–77% of our bowel preps have met these adequacy standards and need for intervention has been identified.…”

“…While standards have been published by PEnQuIN, identified pediatric endoscopy standards have been generally conditional recommendations based on low‐quality evidence (1). To improve the evidence in support or against a given standard, additional data such as that collected using our endoscopy note template and our pediatric endoscopy quality data dashboard are needed for evaluation.…”

“…In 2022, an international working group of PEnQuIN published work developing standards and indicators relevant for assessing the quality of endoscopic procedures (1). PEnQuIN endoscopy quality metrics focused on 3 subdomains: preprocedural, intraprocedural, and postprocedural.…”

Bowel preparation for pediatric colonoscopy: Which regimen is the best?

“…In the recent endoscopy quality guidelines for pediatric endoscopy, a minimum target for the key quality indicator “rate of adequate bowel preparation” was set at ≥80% 10,11 . However, the current evidence supporting this indicator is limited, and there is uncertainty about the definition of “adequate”.…”

“…In the recent endoscopy quality guidelines for pediatric endoscopy, a minimum target for the key quality indicator "rate of adequate bowel preparation" was set at ≥80%. 10,11 However, the current evidence supporting this indicator is limited, and there is uncertainty about the definition of "adequate". A number of bowel preparation scales have been validated in adult colonoscopy, including BBPS, Ottawa Bowel Preparation Scale, and Aronchick Scale; however, their application to pediatrics has not yet been systematically evaluated.…”