Development and usability of an endoscopist report card assessing ERCP quality

Suqing Li; Seremi Ibadin; Christina R Studts; Susan E Jelinski; Steven J Heitman; Robert J Hilsden; Rachid Mohamed; Arjun Kundra; Peter McCulloch; Gregory A Coté; James M Scheiman; Rajesh N Keswani; Sachin Wani; B Joseph Elmunzer; Khara M Sauro; Nauzer Forbes

doi:10.1016/j.gie.2024.10.010

Development and usability of an endoscopist report card assessing ERCP quality

Gastrointest Endosc. 2024 Oct 12:S0016-5107(24)03590-9. doi: 10.1016/j.gie.2024.10.010. Online ahead of print.

Authors

Suqing Li¹, Seremi Ibadin², Christina R Studts³, Susan E Jelinski⁴, Steven J Heitman⁵, Robert J Hilsden⁵, Rachid Mohamed², Arjun Kundra⁶, Peter McCulloch⁷, Gregory A Coté⁸, James M Scheiman⁹, Rajesh N Keswani¹⁰, Sachin Wani¹¹, B Joseph Elmunzer¹², Khara M Sauro¹, Nauzer Forbes⁵

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
² Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
³ Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁴ Alberta Health Services Digestive Health Strategic Clinical Network, Edmonton, Alberta, Canada.
⁵ Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
⁶ Division of Gastroenterology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁷ Patient Safety Academy, University of Oxford, Oxford, UK; Nuffield Department of Surgical Science, University of Oxford, Oxford, UK.
⁸ Division of Gastroenterology and Hepatology, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
⁹ Digestive Health Center, University of Virginia, Charlottesville, Virginia, USA.
¹⁰ Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹¹ Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
¹² Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA.

PMID: 39401600
DOI: 10.1016/j.gie.2024.10.010

Abstract

Background and aims: Audit and feedback (A&F) for ERCP is relatively understudied despite the demonstrated effectiveness of A&F for endoscopic procedures such as colonoscopy. Endoscopist "report cards" are one such A&F tool. We aimed to develop an ERCP report card and assess its appropriateness, acceptability, and feasibility through usability testing.

Methods: A prototype report card was designed using a combination of published quality indicators and established predictors of adverse events (AEs). Exploratory analyses from a prospective multicenter registry were performed to further identify novel and/or understudied parameters for possible inclusion. Semistructured interviews with ERCP endoscopists were conducted and framework analysis performed. Validated postinterview usability instruments were administered. Feedback was incorporated to create a final report card.

Results: The report card included domains of technical parameters, AE rates and prevention, and patient-reported experience measures (PREMs). Qualitative feedback was positive, with respondents agreeing with inclusion of relevant content in most domains. Postinterview instruments revealed adequate appropriateness and acceptability. PREMs were believed by respondents to be poorly actionable and were replaced with appropriateness of indication and fluoroscopy usage parameters in the final report card. Concerns were raised regarding the feasibility of implementation because of reliance on difficult-to-obtain granular intraprocedural data.

Conclusions: We designed and tested an ERCP report card that has the potential to be an effective A&F intervention for endoscopists in clinical practice. Although feasibility of data capture and implementation are currently limitations, advances in video recording and artificial intelligence technologies could accelerate widespread adoption of such a tool.