Colonoscopy is an excellent area for quality improvement because it is high volume, has significant associated risk and expense, and there is evidence that variability in its performance affects outcomes. The best end point for validation of quality metrics in colonoscopy is colorectal cancer incidence and mortality, but a more readily accessible metric is the adenoma detection rate. Fourteen quality metrics were proposed in 2006, and these are described in this article. Implementation of quality improvement initiatives involves rapid assessments and changes on an iterative basis, and can be done at the individual, group, or facility level.
Quality in colonoscopy is essential to maintaining the trust of patients and the public.
Several metrics have been suggested as quality indicators, including appropriate screening/surveillance intervals, adenoma detection rates, cecal intubation rates, and appropriate documentation.
Implementation of quality improvement projects requires identification of a problem and outcome for measurement and development of an intervention followed by frequent short-term assessments and adjustments.
The electronic health records and other registries facilitate quality reporting and measurement.