Abstract
Background: Caecal intubation rate (CIR) is an established performance indicator of colonoscopy. Caecal intubation with acceptable tolerance is only achieved in some patients with more sedation. This study proposes a composite Performance Indicator of Colonic Intubation (PICI) combining CIR, comfort and sedation.
Methods: Data from 20085 colonoscopies reported in the 2011 UK national audit were analysed. PICI was defined as percentage of procedures achieving caecal intubation with median dose (2mgs) of midazolam or less, and nurse-assessed comfort score of 1-3/5. Multivariate logistic regression analysis evaluated possible associations between patient, unit, colonoscopist and diagnostic factors and PICI.
Results: PICI was achieved in 54.1% of procedures. PICI identified factors affecting performance more frequently than single measures such as CIR and polyp detection, or CIR + comfort alone. Older age, male sex, adequate bowel preparation and FOBT screen-positive as indication were associated with a higher PICI. Unit accreditation, the presence of magnetic imagers in the unit,
greater annual volume, fewer years’ experience and higher training/trainer status were associated with higher PICI rates. Procedures in which PICI was achieved were associated with significantly higher polyp detection rates than when PICI was not achieved.
Conclusions: PICI provides a simpler picture of performance of colonoscopic intubation than separate measures of CIR, comfort and sedation. It is associated with more factors that are amenable to change that might improve performance and with higher likelihood of polyp detection. It is proposed that PICI becomes the key performance indicator for intubation of the colon in colonoscopy quality improvement initiatives.
Methods: Data from 20085 colonoscopies reported in the 2011 UK national audit were analysed. PICI was defined as percentage of procedures achieving caecal intubation with median dose (2mgs) of midazolam or less, and nurse-assessed comfort score of 1-3/5. Multivariate logistic regression analysis evaluated possible associations between patient, unit, colonoscopist and diagnostic factors and PICI.
Results: PICI was achieved in 54.1% of procedures. PICI identified factors affecting performance more frequently than single measures such as CIR and polyp detection, or CIR + comfort alone. Older age, male sex, adequate bowel preparation and FOBT screen-positive as indication were associated with a higher PICI. Unit accreditation, the presence of magnetic imagers in the unit,
greater annual volume, fewer years’ experience and higher training/trainer status were associated with higher PICI rates. Procedures in which PICI was achieved were associated with significantly higher polyp detection rates than when PICI was not achieved.
Conclusions: PICI provides a simpler picture of performance of colonoscopic intubation than separate measures of CIR, comfort and sedation. It is associated with more factors that are amenable to change that might improve performance and with higher likelihood of polyp detection. It is proposed that PICI becomes the key performance indicator for intubation of the colon in colonoscopy quality improvement initiatives.
Original language | English |
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Pages (from-to) | 40-51 |
Journal | Endoscopy |
Volume | 50 |
Issue number | 01 |
Early online date | 28 Jul 2017 |
DOIs | |
Publication status | Published - 1 Jan 2018 |
Keywords
- Colonoscopy
- Audit
- Colorectal cancer
- Adenoma Detection Rate
- Caecal Intubation Rate
- Accreditation
- POlyp
- Gastrointestinal Endoscopy
- Performance Indicator