Implementing educational interventions and key performance measures sustains quality of endoscopic assessment in patients with Barrett's esophagus.

Abstract

Background and study aims: Quality metrics for Barrett's esophagus (BE) are anticipated to improve outcomes for patients through earlier detection of neoplasia. The European Society of Gastrointestinal Endoscopy has developed guidelines to homogenize endoscopic quality in BE. Our study aimed to assess the impact of recommended key performance measures (KPMs) and their sustainability.

Patients and methods: A single-center, retrospective study (Phase 1) was conducted over 8 weeks. The KPMs assessed were: 1) pre-procedure metrics including indication, consent, safety checklist (target of 100%); and 2) Prague classification, Seattle protocol, or targeted biopsies, inspection time of 1 minute per cm, advanced imaging and surveillance recommendations (target of 90%). Following baseline analysis, multimodal educational interventions were implemented and repeated at 6-month intervals. Repeat analysis was performed at 6 months and 1 and 3 years (Phases 2, 3 and 4 respectively).

Results: In Phase 1, 39 patients with BE underwent endoscopy. Phase 2 evaluated 40 patients with BE. Phase 3 analyzed 59 patients with BE, and Phase 4 identified 34 patients with BE. Pre-procedure metrics were met in 100% of patients across the 3-year period. Baseline analysis displayed suboptimal performance at 45% to 75% for all other KPMs. However, after regular multimodal educational interventions, quality standards significantly improved and were able to be maintained over all phases, achieving pre-set targets of >9 0% for all KPMs except one.

Conclusions: Sustaining improvements in quality metrics in Barrett's endoscopy is important. Our study suggests that regular, replicable education interventions have a positive effect and allow sustained long-term improvements in quality metrics.