A Fellow-Led Quality Improvement Project on Colon Polyp Documentation

Abstract

Introduction: Colon polyp morphology and pit pattern recognition have become an important part of polyp management. Our gastroenterology division recently decided to mandate the documentation of all colon polyps' morphology (by Paris classification) and pit pattern (by Kudo classification). An internal review was then conducted to evaluate the documentation of these parameters for all colonoscopies with polypectomies performed by fellows at our institution over time. Methods: A retrospective chart review was performed. Each fellow evaluated his or her co-fellow's (same PGY) colonoscopies with polypectomy before and after the implementation of the new mandate on March 26th, 2018. The review included parameters such as procedure date, number of polypectomies performed, and whether or not Paris classification and Kudo pit patterns were documented for each polyp. This data was presented to the division as a QA project and fellow education was performed. A third review was then conducted for a total of 30 colonoscopies with polypectomy six weeks later. Results: On initial review, a total of 60 and 55 colonoscopies with polypectomy were evaluated before and after March 26th, 2018 respectively. A total of 183 and 182 polypectomies respectively were performed during these procedures. Prior to March 26th, only 5% (n=8) of polyps had Paris classifications or Kudo pit patterns documented. After implementation of the new polyp morphology and pit pattern mandate, 48% (n=87) of polyps had documented Paris classifications and 29% (n=53) of polyps had documented Kudo pit patterns. The third review of 30 fellow colonoscopies with 99 total polypectomies six weeks later revealed that 83.8% (n=83) of polyps had both Paris classification and Kudo pit pattern documentation. Conclusion: Prior to implementation of the new polyp documentation mandate on March 26th, 2018, only 5% of fellow colonoscopies with polypectomy had documentation of polyp morphology and pit patterns. After the mandate, 48% of polyps had Paris classification documentation and 29% had Kudo pit pattern documentation. A substantial improvement was further seen after fellow education and re-evaluation with 83.8% of all polyps containing both morphology and pit pattern documentation. Fellow-led quality improvement projects can enhance awareness of group performance and improve outcomes related to divisional patient care goals.