How do you measure performance as a colonoscopist?

Colorectal Dis. 2011 Aug;13(8):939-43. doi: 10.1111/j.1463-1318.2010.02344.x. Epub 2010 Jun 2.


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.

MeSH terms

  • Clinical Competence / standards*
  • Colonoscopy / economics*
  • Colonoscopy / education
  • Colonoscopy / standards*
  • Cost-Benefit Analysis / methods
  • Humans
  • Outcome Assessment, Health Care / methods*
  • Practice Guidelines as Topic