High-quality colonoscopy: using Textbook Process as a composite quality measure

Karlijn J. Nass, Sascha C. van Doorn, Paul Fockens, Colin Rees, Maria Pellisé, Manon van der Vlugt, Evelien Dekker

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Background: High-quality colonoscopy is fundamental to good patient outcomes. Textbook Outcome has proven to be a feasible multidimensional measure for quality assurance between surgical centers. In this study, we sought to establish Textbook Process (TP) as a new composite measure for the optimal colonoscopy process and assessed how frequently TP was attained in clinical practice and the variation in TP between endoscopists. Methods: To reach consensus on the definition of TP, international expert endoscopists completed a modified Delphi consensus process. Then, the achievement of TP was applied to clinical practice. Prospectively collected data in two endoscopy services were retrospectively evaluated. Data on colonoscopies performed for symptoms or surveillance between 01-01-2018 and 31-07-2021 were analyzed. Results: The Delphi consensus process was completed by 20 of 27 invited experts (74.1%). TP was defined as a colonoscopy fulfilling the following items: explicit colonoscopy indication, successful cecal intubation, adequate bowel preparation, adequate withdrawal time, acceptable patient comfort score, provision of post-polypectomy surveillance recommendations in line with guidelines, and the absence of the use of reversal agents, early adverse events, readmissions and mortality. In the two endoscopy services studied, TP was achieved in 5.962 of 8.227 (72.5%) colonoscopies. Of 48 endoscopists performing colonoscopy, attainment of TP varied significantly, ranging from 41.0% to 89.1% per endoscopist. Conclusion: This study proposes a new composite measure for colonoscopy: Textbook Process. TP gives a comprehensive summary of performance and demonstrates significant variation between endoscopists, illustrating the potential benefit of TP as measure in future quality assessment programs.
Original languageEnglish
Publication statusE-pub ahead of print - 2022

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