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The Role of the Global Rating Scale in Colonoscopy Quality Donald - - PowerPoint PPT Presentation
The Role of the Global Rating Scale in Colonoscopy Quality Donald - - PowerPoint PPT Presentation
The Role of the Global Rating Scale in Colonoscopy Quality Donald MacIntosh MD MSc FRCPC Division of Gastroenterology Dalhousie University Conflict of Interest None to declare Do We Need Endoscopy QA? Would You Allow Any Random Endoscopist
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Do We Need Endoscopy QA?
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Would You Allow Any Random Endoscopist In The Area Where You Live Do YOUR Colonoscopy?
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There are golfers of variable skills
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10 20 30 40 50 60 70 80 90 100
A B C D E F G H I J K L M N O P Q R
Credentialed*Colonoscopists
who*performed*more*than*20*program*procedures between**April*6,*2009*<*June*30,*2011
%
Carcinoma Adenoma*< Advanced Adenoma*<*Low Grade
There are colonoscopists of varying skills
who
From which group
- f physicians
would you choose YOUR colonoscopist:
A !B
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So why shouldn’t it also apply to endoscopy units?
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Patient Perspectives
I have no issues on safety or quality. Should I be worried? I’m sure they have a safety department that checks the equipment is up to date and clean. And the doctors must have to
show they are keeping their skills up to date,
this does not worry me, it’s a major hospital, they have to
have standards or they would be in trouble.
Sewitch, Dube personal communication
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We Do Need Quality Improvement From The Patient Perspective
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The Endoscopy Global Rating Scale (GRS)
- A structured approach for endoscopy
units
- How to provide a good quality experience
for patients
1.
How good the services provided within the unit are
2.
What needs to be done to further improve the services
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History
Developed in England Response to quality audits
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Structure
Questionnaire in Yes/No format Done twice a year Grade D to A
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Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No
There are procedure specific aftercare patient information sheets for all procedures performed in the department There is a 24 hour contact number for patients who have questions and experience problems All patients are told if they are suspected of having a malignancy on the same day as the procedure If it is considered inappropriate to tell the patient malignancy is suspected, a note is made in the file of the reason All patients are discharged with verbal and written information about next steps appropriate for their care All patients are told the outcome of the endoscopic procedure prior to discharge All patients are told if further information from pathological specimens will be available, from whom and when Patients’ views on aftercare processes are sought at least annually
C B
Item – aftercare, levels C and B
www.grs.nhs.uk
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Grades
D – Basic methods for gathering of data C – Periodic reviews of data. Surveys. B – Respond to reviews indicating need for improvement A – Assess the changes made
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Charts The Patient Journey
Before: consent, information provided, access During: privacy, comfort, safety After: communicating test results, FU plans
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Patient-centred standards
Clinical quality
- appropriateness
- information/consent
- safety
- comfort
- quality
- timely results
www.grs.nhs.uk
Quality of patient experience
- equality
- timeliness
- choice
- privacy and dignity
- aftercare
- ability to provide feedback
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KMS Library
Shared documents FAQs Helps units improve rapidly
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Canadian&GRS &
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Who Cares? Thats A Lot Of Work
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Why A Screening Program Should Consider Using GRS
A mechanism for quality improvement " A means to increase access " Gets members of the unit involved" Facilitates communication between the different endoscopy services "
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