Objective Monitoring of key performance indicators (KPIs) is a vital element of endoscopy quality improvement. Adenoma detection rate (ADR) is considered the best marker for colonoscopic quality as it inversely correlates with subsequent colonic cancer incidence and mortality, while polyp detection rate (PDR) is an easier-to-calculate surrogate for ADR. This study assessed whether regular feedback to individual endoscopists about their KPIs improved departmental performance.
Methods Individual KPIs were calculated for a period of 8 years (January 2012–December 2019) and fed back to all endoscopists at 6 monthly intervals, alongside anonymised indicators for other endoscopists, aggregate departmental performance data and benchmarks. An automated natural language processing software (EndoMineR) was used to identify adenomas in pathology reports and calculate ADR. Linear regressions were calculated for departmental ADR, PDR and other KPIs at 6 monthly intervals.
Results 39 359 colonoscopies (average 2460 in every 6-month period, range 1799–3059) were performed by an average of 42 (range 34–50) endoscopists. A continuous improvement in collective performance including ADR (12.7%–21.0%, R2 0.92, p<0.001) and PDR (19.0%–29.6%, R2 0.77, p<0.001) was observed throughout the study. Other KPIs showed similar improvement. The detection of non-neoplastic polyps did not increase. When analysed separately, ADR and PDR appeared to improve for gastroenterologists and nurse endoscopists but not for surgeons.
Conclusion Regular feedback with individual and departmental KPIs was associated with improved ADR and overall performance throughout the 8-year study period. Concomitant monitoring of ADR and PDR may prevent ‘gaming’ behaviour and ensure that genuine improvement is achieved.
- colonic adenomas
- colonic polyps
- colorectal cancer
Data availability statement
Data are available upon reasonable request. Individual anonymised data are available on request.
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Contributors SL contributed to the analysis of the data, writing and reviewing the manuscript, tables and figures. GT contributed to the design of the study, collection and analysis of the data, writing and reviewing the manuscript, tables and figures. SZ developed the software to automatically identify colonic adenomas from pathology reports, allowing easier calculation of the adenoma detection rate. SDM designed and conducted the study, calculated individual and collective key performance indicators, sent regular feedback to all the endoscopists during the study period, collected the data and reviewed the manuscript. SL, GT and SDM are responsible for the overall content of the study. GT acts as guarantor for the study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.