ACG, ASGE update quality indicators for ‘delivery of high-quality’ GI endoscopy
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Key takeaways:
- This update is the third iteration of ASGE/ACG quality indicators documents for GI endoscopic procedures.
- The quality indicators have been divided into pre-, intra- and postprocedural periods.
The ACG and ASGE have released an updated quality indicators document, intended to serve as a framework to improve performance of endoscopic procedures.
“The field of endoscopy has evolved substantially in recent years, with advances in procedural capabilities, technologies and delivery models,” B. Joseph Elmunzer, MD, MSc, the Peter B. Cotton Professor of Medicine & Endoscopic Innovation at the Medical University of South Carolina, and colleagues wrote in the American Journal of Gastroenterology and Gastrointestinal Endoscopy. “One constant, however, has been the commitment of professional societies, including the ASGE and the ACG — the two cosponsors of this series — to the delivery of high-quality endoscopic care.”
They continued: “This commitment is reflected, in part, by quality indicator documents, which aim to provide endoscopists and practices a framework through which quality improvement efforts can be operationalized.”
This document is the third iteration in the series and builds upon previous work by the ASGE/ACG Task Force on Quality Endoscopy, first published in 2006 and revised in 2015. The revision features updated data on existing quality indicators and introduces new indicators with wide-ranging clinical implications during pre-, intra- and post-procedural periods.
The task force assessed existing quality indicators and through consensus decided whether they should be maintained or removed based on ongoing relevance and strength of evidence. When necessary, the authors performed a literature search to aid in the strength of recommendation for each indicator, most of which have a performance target of more than 98%, meaning they “should be achieved in nearly every case.” Each quality indicator was further categorized as an outcome or process measure.
The task force came to a consensus on 19 quality indicators, which include:
- For every endoscopic procedure, an indication should be documented from the published standard list of appropriate indications. Endoscopies performed for non-standard reasons should be justified in the documentation.
- Consent should always be obtained and documented prior to endoscopy and include discussion of the sedation plan, indication and description of the procedure, likely benefits and common adverse events, alternative procedures and patient prognosis if treatment is declined. Consent may be bypassed in some cases of emergency.
- Prophylactic antibiotics should be administered in select settings for which evidence has shown benefit, although providers should prioritize judicious use of antibiotics to minimize unnecessary administration.
- A periprocedural management plan for antithrombotic medications should be documented before the procedure and communicated to the patient and health care team.
- The interruption and/or premature termination of a procedure as a result of a sedation-related event should be documented.
- Documentation confirming the patient met discharge criteria is required prior to discharge from the endoscopy unit, and all discharge instructions should adhere to ASGE guidelines.
- Adverse events should be documented and classified by their timing, level of certainty related to the endoscopic procedure and the degree of impact on the patient.
“Given the fundamental nature of these indicators, the value of their enumeration and discussion might be questioned,” Elmunzer and colleagues wrote. “However, data suggest that there remains a lack of adherence to these indicators. Procedures are still performed for questionable indications, adverse events are not always captured and documented, and communication between the endoscopist and patient and/or involved clinicians is sometimes lacking.”
They continued: “For these reasons, strict attention to the quality indicators in this document, and an active plan for improvement in areas of measured deficiency, should be a central pillar of the successful practice of endoscopy.”
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Elmunzer BJ, et al. Am J Gastroenterol. 2024;doi:10.14309/ajg.0000000000002988.
Elmunzer BJ, et al. Gastrointest Endosc. 2024;doi:10.1016/j.gie.2024.05.001.
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