Évaluation de la qualité des soins en endoscopie digestive : étude de 202 coloscopies totales consécutives

Abstract

The aim of this study was to evaluate the quality of the medical care associated with the colonoscopies performed in our gastrointestinal endoscopy unit. This 6-month prospective, comparative study used process and result indicators. Its long-term objective was to improve the quality of care and to select a few pertinent quality indicators for continual monitoring. An audit was conducted of all total colonoscopies performed at our general hospital from November 2005 through May 2006. It assessed the principal published process and result indicators for the medical aspects of the procedure as well as patient satisfaction (indication, procedure itself, results, complications, satisfaction). These indicators were also compared between endoscopists. During the 6-month study period, 202 total colonoscopies were performed. Waiting time for the procedure, appropriateness of the indication, proportion of colonoscopies completed, proportion of neoplastic lesions found, adequacy of bowel preparation, frequency of complications, and patient satisfaction were similar to and even above the standard values. However, patient information and the completeness of the legal documents were insufficient. Although the mean values were satisfactory, detailed individual analysis showed statistically significant differences between endoscopists. For example, the proportion of withdrawal times exceeding 6 minutes was 16.3%, 25.0% and 86.4% according to endoscopist. The mean number of polyps each removed per procedure was respectively 1, 2, and 3 (p<0.05). An improvement plan was implemented in view of these results, and appropriate simple indicators were selected for prospective monitoring. Despite the overall results, which essentially complied with standard guidelines, our prospective and comparative audit of colonoscopies pointed out significant variations between individual endoscopists and helped us to define improvement actions and indicators.