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Sustained colonoscopy quality improvement using a simple intervention bundle

Lookup NU author(s): Dr Laura Neilson, Dr Roisin Bevan, Professor Colin Rees


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© Georg Thieme Verlag KG Stuttgart · New York. BACKGROUND: Unacceptable variation in colonoscopy quality exists. The Quality Improvement in Colonoscopy (QIC) study in 2011 improved quality by introducing an evidence-based "bundle" of measures into routine colonoscopy practice. The QIC bundle included: minimal cecal withdrawal time of ≥ 6 minutes; hyoscine butylbromide use; supine patient position for transverse colon examination; rectal retroflexion. Colonoscopy quality was measured by adenoma detection rate (ADR). The current study measured whether these effects led to a sustained change in practice 3 years following implementation. METHODS: This observational study collected data from eight hospital trusts (sites) in the United Kingdom for a 6-month period, 3 years following QIC bundle implementation. Use of the antispasmodic, hyoscine butylbromide, was measured as a marker of bundle uptake. Bundle effectiveness was measured by ADR change. Comparisons were made between data before and immediately after implementation of the bundle. RESULTS: 28 615 colonoscopies by 188 colonoscopists were studied. Hyoscine butylbromide use increased from 15.8 % pre-implementation to 47.4 % in the sustainability phase (P < 0.01) indicating sustained engagement with QIC measures. ADR was higher in the sustainability period compared with pre-intervention, but only reached statistical significance among the poorest-performing colonoscopists. CONCLUSIONS: The introduction of a simple, inexpensive, pragmatic intervention significantly changed practice over a sustained period, improving colonoscopy quality as measured by ADR, particularly in poorer performers. QIC demonstrates that an easy-to-implement quality improvement approach can deliver a sustained change in practice for many years post intervention.

Publication metadata

Author(s): Neilson LJ, East JE, Rajasekhar PT, Bassett P, Dunn S, Bevan R, Paremal S, Esmaily S, Rees CJ

Publication type: Article

Publication status: Published

Journal: Endoscopy

Year: 2020

Volume: 52

Issue: 4

Pages: 285-292

Print publication date: 01/04/2020

Online publication date: 02/03/2020

Acceptance date: 16/12/2019

ISSN (print): 0013-726X

ISSN (electronic): 1438-8812

Publisher: Georg Thieme Verlag


DOI: 10.1055/a-1098-2101

PubMed id: 32120412


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