Tu1978 WHERE DO WE GO FROM HERE? PROCESS AND IMPLEMENTATION OF A DETAILED QUANTITATIVE AND QUALITATIVE REPORT CARD FOR BOTH GASTROSCOPY AND COLONOSCOPY

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Background: Quality in colonoscopy has been measured at two Queensland hospital endoscopy units in a structured key performance indicators (KPIs) report since July 2014. In this time, KPIs have increased from minimum accepted baselines to substantially higher levels, before plateauing. Initially, the provision of individual KPI data were enough to increase endoscopist engagement and improve KPIs, with additional anonymized comparison data provided to maintain motivation over time. Gastroscopy report quality had not previously been addressed. Methods: We undertook a comparative literature search to identify significant journal articles and international endoscopy society position papers that identified, collated, and stratified potential indicators of evidence of a quality procedure. Potential new indicators were identified for a feasibility review to delineate the relative weighting of each of the indicators for inclusion. On agreement, a comprehensive and detailed instruction manual was developed. A test run was completed to ensure that the communication of the new indicators was sufficient and that the database could accurately capture required information. Once confirmed, the indicators were endorsed and introduced. Results: Indicators were separated by procedure, report, and procedure quality (Fig. 1). Indicators with a strong body of evidence or required by government were considered “Level 1.” Indicators with a moderate body of evidence or that focused on morbidity were considered “Level 2.” The remainder were classified “Level 3” and should be considered in the wider context of an endoscopist's performance. Evidence from the first 10 months of implementation (5265 colonoscopies, 3397 gastroscopies) shows that procedure quality remains high across all levels of indicators and supports inclusion of additional measures that further help to stratify the high‐performing field. However, evidence regarding the level of report quality (Level 2), primarily the issue of photo documentation, had a slower rise from baseline. In this area, endoscopists are routinely photographing relevant landmarks but struggle to use the software to accurately label the landmark. Feedback and in‐procedure room support were offered to all endoscopists who were unable to meet these Level 2 indicator thresholds, with a noticeable improvement in the latter half of 2019 (Fig. 1). Conclusion: The development of additional indicators for endoscopy was welcomed by the endoscopists and supported by management. The implementation continues to show progressive improvement and has allowed for opportunities to motivate high‐performing endoscopists. Future plans will expand the indicators to include each endoscopist's contribution to wider unit‐based measures, such as time tracking of patients through each procedure stage, adherence to the new Australian Medicare billing guidelines, and overall patient satisfaction.