alaa rostom, md, msc, frcpc cddw...quality = doing the right thing =quality and safety of the...

Alaa Rostom, MD, MSc, FRCPC

CDDWFebruary 2014

Co-Chair of CAG SEE ProgramNo financial COI

BackgroundParadigms of Quality in

EndoscopySEE Program

Residency based• Apprenticeship model• Non-standardized teaching• Non standardized evaluation• Sign off by program

Never tested againSkills not part of mainCert

Quality = doing the right thing=Quality and safety of the procedure

Society has expectations• Responsible use of limited resources

Appropriate procedures

• Patient-centered services Procedures performed expeditiously,

successfully, safely & comfortably Indications, process and results are well

communicated

Quality

Measureindicator

Feedbackresults

Implementchanges

Monitorthe impactof changes

Improve qualityMaintain

standards

Endoscopy technique

Quality

safety

comfort

sedation

The colon was completely examined• Proof of cecal intubation, rectal retroflexion

The colonic mucosa was well visualized• Quality of the bowel prep, withdrawal technique

No significant pathology was missed• Interval cancer

The consequences of suboptimal quality are not immediately apparent

Colonoscopy outcomes• Withdrawal Technique• Adenoma detection rate• Mean adenomas per procedure• Missed cancer rate• Procedural comfort (NAPCOMS)• Bowel Prep• Procedural safety

Sedation and reversal agent use Perforation Bleeding

Colonoscopy skill per se• JAG DOPS, practice audit Walsh Scale, others

Endoscopy QualityMonitoring

QA Program Endoscopist Feedback Report

Continual QualityImprovement

Train the Trainers & Up skilling

MainCert / RCPSC

Residency training program needs

Provincial Screening Programs

Individual self improvement

Mandated self improvement

Not prevalent in Canada

• Possibilities include: Provincial CRC screening program requirement Provincial College requirement for NHSF Hospital requirements for reappointment

Developed From the UK Model Predominantly MainCert and individual driven Recognizes three applications / targets

• Train the trainers

• Up-skill courses

• “Remediation”

CAG Program Quality and Education affairs Co-chairs

• Don MacIntosh – Alaa Rostom

Focus• Excellence in educational delivery• Standardized objectives curriculum and Delivery• Regular needs responsive program adjustment

Established Centres• Halifax• Calgary• McGill• Hamilton• Kingston

Certified Fculty• Jon Love• Kevin Waschke• Dana Farina• Lawrence Hookey

Upcoming Centres• Victoria• Vancouver• Ottawa• Newfoundland

Upcoming Faculty Jen Telford Denis Petrunia Frances Tse David Armstrong Steve Heitman

Quarterly TTTs Quarterly Up Skill courses expanded collaboration with

• Provincial screening programs• GI training programs• Royal College• Surgical groups

Maintaining standardized structure and delivery with growth

Incorporating Robust evaluation on individual and programmatic outcomes

Establish and strength partner linkages