How do you measure performance as a colonoscopist?

Aim: The aim of this study was to describe an easy and reproducible method of measuring clinical performance in colonoscopy.

Method: Data from all endoscopy procedures performed within the main endoscopy unit at Derriford Hospital between January and December 2007 were analysed. Points were allocated for given procedures. A local health economic analysis revealed that at least 8 points (or four colonoscopies) must be performed to meet list costs. The clinical performance was described as a capability index of crude Caecal Intubation Rate (CIR) vs the mean Points Performed/Endoscopy List (points/list).

Results: Overall, 3884 colonoscopies were performed, with a mean crude CIR of 89.6% and 8.3 points/List. Only 7/23 endoscopists consistently met the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) standard in a cost-effective way. An annual colonoscopy rate of ≥ 150 cases was associated with higher points per list (points/list) (P = 0.003). Endoscopists offering ≥ 15% of cases as training cases had significantly higher crude CIRs and points/list (P = 0.051; P = 0.017).

Conclusions: Clinical performance is a function of quality provided in a cost-effective way. Our capability index is an effective and reproducible way of measuring clinical performance. Training was not associated with reduced volume.