8 WORLD GASTROENTEROLOGY NEWS SEPTEMBER 2015 Editorial | Expert Point of View | Gastro 2015: AGW/WGO | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events Quality in Gastrointestinal Endoscopy in 2015. Providing the Best Care for Our Patients Maria Claudia Stefanoli, MD Gastroenterology and Digestive Endoscopy Service Hospital Maciel Montevideo, Uruguay 1. Introduction Over the last four decades, GI en-doscopy has become of paramount importance to diagnose, treat, and prevent diseases of the digestive tract. These procedures are invasive and have the potential to cause harm to the patient, so every time an endosco-py is indicated, the benefits obtained from it must outweigh the risks of the procedure. Because the quality of endoscopy can vary we must be sure we are providing the highest possible standard of care. How can we measure quality? The quality of health care can be measured by comparing the perfor-mance of an individual or a group of individuals, with an ideal or benchmark. Each parameter used for comparison is named a quality indicator. For example a high quality endoscopy is an examination in which the procedure is indicated, the correct diagnoses are made or excluded, the therapy provided is appropriate, and all the risks have been minimized.1,19 2. Quality indicators 18 As the demand for quality control in endoscopic procedures has grown all over the world, the creation of effective quality control guidelines has become a need. Moreover it is necessary to translate these guidelines into practical recommendations that can be imple-mented in the endoscopy units. There are 3 categories of quality indicators: 1) Structural measures (they assess availability and maintenance of endoscopy equipment in an en-doscopy unit) 2) Process measures (they assess performance during the delivery of care) 3) Outcome measures (they assess results of endoscopies in a period of time) This review will focus on item 2 above, the process measures of endoscopy. These quality indicators can also be divided into three time periods: preprocedure, intraprocedure, and postprocedure. Preprocedure, is the period of time before sedation is started or the introduction of the endoscope. During this period there are common issues for all endoscopic procedures, which include: correct indication, informed consent, risk assessment, sedation plan, manage-ment of prophylactic antibiotics and of anti-thrombotic drugs. 2a. Indications for the Procedure The indication, included in a pub-lished standard list of appropriate indications, must be documented (priority indicator). A quality im-provement goal is to minimize the number of endoscopies done without appropriate indications. For open access endoscopy, where non gastro-enterologists schedule patients for endoscopy, most studies have shown that the procedures are done for ap-propriate indications.2, 3, 4 Two other quality improvement goals are to allow for feedback to referring physicians with regard to appropriateness of indication, and how information about the procedure will be provided to patients before the endoscopy. 2b. Informed Consent Informed consent should be obtained and documented in every procedure, except in rare emergency cases or with non-competent patients.5, 6 The consent should be obtained personally by the endoscopist and should specifically address and docu-ment the most common complica-tions (bleeding, perforation, missed diagnosis, and sedation-related complications), facilitating a full discussion with the patient. 7 This is especially important if there is a subsequent medico-legal case. 8 When sedation is provided by an anesthetist, there should be a sepa-rate consent form, which should be obtained by that specialist. 2c. Pre Procedure Patient Evaluation Pre-procedure history and physical examination should be done and documented.9, 10 The history should focus on indications, as well as condi-tions that may affect the performance and safety of the procedure. This includes sedation-related issues (ab-normalities of major organ systems, previous adverse events with sedation or anesthesia, medication allergies, current medications, potential medi-cation interactions, smoking, alcohol or substance use or abuse). It should
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