Implications of stable or increasing adenoma detection rate on the need for continuous measurement

Long-Term Follow-Up of Colonoscopy Quality Monitoring

INTRODUCTION

High-quality colonoscopy is paramount for colorectal cancer prevention. Since 2009, endoscopists at our institution have received quarterly report cards summarizing individual colonoscopy quality indicators. We have previously shown that implementing this intervention was associated with short-term improvement in adenoma detection rate (ADR). However, the long-term effect of continued monitoring on colonoscopy quality is unclear.

METHODS

We conducted a retrospective study of prospectively administered quarterly colonoscopy quality report cards at the Roudebush Veteran's Affairs Medical Center between April 1, 2012, and August 31, 2019. The anonymized reports included individual endoscopists' ADRs, cecal intubation rates, and withdrawal times. Analyses were performed to determine slopes over time for each quality metric by physician and assess for differences based on whether ADRs were calculated quarterly or yearly.

RESULTS

Data from the report cards of 17 endoscopists who had performed 24,361 colonoscopies were included. The mean quarterly ADR (±SD) was 51.7% (±11.7%) and mean yearly ADR was 47.2% (±13.8%). There was a small increase in overall ADR based on quarterly and yearly measurements (slope + 0.6%, P = 0.02; and slope +2.7%, P < 0.001, respectively), but no significant change in individual ADRs, cecal intubation rates, or withdrawal times. Analysis of SD of ADRs showed no significant difference between yearly and quarterly measurements ( P = 0.064). Individual endoscopists' ADR SD differences between yearly and quarterly measurements ranged from -4.7% to +6.8%.

DISCUSSION

Long-term colonoscopy quality monitoring paralleled stable improvements in overall ADR. For endoscopists with baseline high ADR, frequent monitoring and reporting of colonoscopy quality metrics may not be necessary.

Predicting the future: introducing business analytics to endoscopy units

BACKGROUND AND AIMS

currently, most endoscopy software only provides limited statistics of past procedures, while none allows patterns to be extrapolated. To overcome this need, the authors applied business analytic models to predict future demand and the need for endoscopists in a tertiary hospital Endoscopy Unit.

METHODS

a query to the endoscopy database was performed to retrieve demand from 2015 to 2021. The graphical inspection allowed inferring of trends and seasonality, perceiving the impact of the COVID-19 pandemic, and selecting the best forecasting models. Considering COVID-19's impact in the second quarter of 2020, data for esophagogastroduodenoscopy (EGD) and colonoscopy was estimated using linear regression of historical data. The actual demand in the first two quarters of 2022 was used to validate the models.

RESULTS

during the study period, 53,886 procedures were requested. The best forecasting models were: a) simple seasonal exponential smoothing for EGD, colonoscopy and percutaneous endoscopic gastrostomy (PEG); b) double exponential smoothing for capsule endoscopy and deep enteroscopy; and c) simple exponential smoothing for endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). The mean average percentage error ranged from 6.1 % (EGD) to 33.5 % (deep enteroscopy). Overall, 8,788 procedures were predicted for 2022. The actual demand in the first two quarters of 2022 was within the predicted range. Considering the usual time allocation for each technique, 3.2 full-time equivalent endoscopists (40 hours-dedication to endoscopy) will be required to perform all procedures in 2022.

CONCLUSIONS

the incorporation of business analytics into the endoscopy software and clinical practice may enhance resource allocation, improving patient-focused decision-making and healthcare quality.