Recommendations were endorsed if more than 80 per cent of experts agreed with the statement (consensus). In recent years, the volume of endoscopic procedures in Canada, such as colonoscopies, has been increasing and demand is exceeding supply. In response, over the past decade the CAG has developed and implemented a number of programs to promote greater safety and quality in endoscopic services. For example, Canada has adopted the Global Rating Scale (GRS), a web-based endoscopy evaluation tool that evaluates multiple components of endoscopy service from a patient-focused perspective. The Consensus Guidelines – in the making for three years – is a natural extension of the GRS and related programs that support the CAG’s commitment to safe, high-quality patient-centered care. “Now that the guidelines are in place, we will work with our members, our partners, provincial gastroenterology associations and other stakeholders to promote their broad implementation across Canada,” said Dr. David Morgan, President of the CAG. “The CAG is committed to provide those who deliver endoscopic services with tools they need to ensure patient-centered, quality service in their day-to-day practice”. Download an executive summary of The Canadian Association of Gastroenterology Consensus Guidelines on Safety and Quality Indicators in Endoscopy . Copies of the full report are available upon request. (i)Endoscopy involves examining the inside of a person’s body using an endoscope – a long, thin tube with a light and camera attached to it.
Gastroenterologists release new safety guidelines
– Canada’s gastroenterologists have new guidelines on safety and quality indicators to help with the more than 1.6 million procedures performed each year, their association announced Monday. Although the Canadian Association of Gastroenterology has guidelines around credentials and training, there was a void in other areas. “If one looks at the sort of totality of endoscopy service delivery, particularly from a patient point of view — which is access to services, rapid access, high quality services, feedback, and an ability to respond to how they perceive endoscopy service delivery — then there really was nothing in place,” said Dr. David Armstrong, chair of the endoscopy committee and the consensus guideline committee. Endoscopy is used to detect or screen for a number of diseases and involves examining the colon or digestive tract using a long, thin tube with a light and camera attached. Last October, about 6,800 Ottawa residents were sent letters from public health officials after it was found that a non-hospital clinic wasn’t following some procedures involving cleaning and infection prevention. The letters indicated the patients might have been exposed to hepatitis B, hepatitis C or HIV. Armstrong said he likes to think the presence of these guidelines would have made a difference in the Ottawa situation. “That’s really because one of the challenges for endoscopy — and it’s in and out of hospitals — has been that if there isn’t a framework to say how things should be monitored and how they should be delivered, it’s difficult to know how much or how closely to monitor things, and what actually are the standards,” Armstrong said in an interview from Hamilton, where he’s an associate professor of medicine at McMaster University. “So I think guidelines that say what should be monitored and what processes have to be in place really from a patient point of view and knowledge that there are tools available to monitor the way that services are delivered and to use as a basis for quality improvement programs would have made a big difference.” Armstrong indicated that it used to be felt that washing the scope and then doing a manual cleaning was sufficient. “And the trouble is there are times when that isn’t sufficient.
Endoscopist specialty is associated with colonoscopy quality
However, despite statistical adjustment, residual confounding due to patient-level risk factors may contribute the observed difference between specialties. Several prior studies have examined the association between endoscopist speciality and missed CRCs. In a retrospective cohort study using population level data from Ontario, Bressler et al. identified endoscopist specialty as a risk factor for incident CRCs post-colonoscopy among both male and female patients [ 16 ]. In contrast to our study, the difference was found mainly between gastroenterologists and primary care physicians, rather than between gastroenterologists and surgeons. This study also found that office colonoscopies are more likely to be associated with missed lesions than hospital-based colonoscopies. A Manitoba study also showed no difference in missed cancers between surgeons and gastroenterologists. This model included colonoscopy volume and practice location (rural vs. urban) as covariates, neither of which was significantly associated with missed cancers [ 18 ]. Rabeneck et al. reported an odds ratio of 1.39 (95% CI: 1.161.67) for the risk of CRC diagnosis after negative colonoscopy in the patients seen by surgeons vs.
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