Evaluation of a quality assurance program for endoscopy services in the Netherlands
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Authors: J. Sint Nicolaas ; V. de Jonge ; F. ter Borg ; J.T. Brouwer ; D.L. Cahen ; F.J.G.M. Kubben ;
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W. Lesterhuis ; W. Moolenaar ; R.J.Th. Ouwendijk ; M.J.F. Stolk ; T.J. Tang ; A.J.P. van Tilburg ; R.
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Valori ; M.E. van Leerdam , E.J. Kuipers
Affiliations: Departments of Gastroenterology and Hepatology of Erasmus MC University Medical
Center, Rotterdam, the Netherlands; Deventer Hospital, Deventer, the Netherlands; Reinier de Graaf
Hospital Group, Delft, the Netherlands; Amstelland Hospital, Amstelveen, the Netherlands; Maasstad
Hospital, Rotterdam, the Netherlands; Albert Schweitzer Hospital, Dordrecht, the Netherlands;
Medical Center Alkmaar, Alkmaar, the Netherlands; Ikazia Hospital, Rotterdam, the Netherlands;
Sint Antonius Hospital, Nieuwegein, the Netherlands; IJsselland Hospital, Capelle aan den IJssel,
the Netherlands; Sint Franciscus Gasthuis, Rotterdam, the Netherlands; Gloucestershire Royal
Hospital, Gloucester, United Kingdom; and Department of Internal Medicine, Erasmus MC University
Medical Center, Rotterdam, the Netherlands
With increasing recognition of variability in quality and safety outcomes in endoscopy there is
increasing need for comprehensive quality assurance (QA) programs. A comprehensive QA program
in endoscopy, called the Global Rating Scale (GRS), has been successfully implemented in England.
The GRS receives wide international attention, but its applicability in other settings has not been
established. As no formal standardized QA program does currently exist in the Netherlands, this study
aimed to determine the applicability of the English GRS system in the Dutch endoscopy setting.
The English GRS consists of 2 main domains: Clinical Quality (CQ) and Quality of Patient Experience
(QPE) evaluating all aspects of the endoscopy unit. Each domain is divided in 6 items, all with 4
performance levels: level A (excellent service), B (achieving standards), C (monitor standards), or D
(basic care, protocols available). Each level is underpinned by measures that must be achieved to
reach a certain level. For the Dutch pilot, the GRS domains CQ and QPE were evaluated after
translation into Dutch and back-translated for validation. Eleven Dutch endoscopy units participated in
completing a GRS pilot census (6 teaching, 5 general hospitals). A gastroenterologist, nurse, and
manager completed the census together.
In the CQ domain high scores in ‘Communicating results to the referrer’ (45% A, n=5/11 hospitals,
Level C) were achieved. CQ items such as ‘Appropriateness’ (82% D, n=9/11) and ‘Quality of
procedure’ (100% D, n=11/11) achieved less favorable scores as Dutch units lack running audit
programs in these areas.
For QPE items such as ‘Timeliness’ (27% A or B, n=3/11) and ‘Booking & Choice’ (36% B, n=4/11)
relatively high scores were achieved in several hospitals. Improvements can be realized in the items
‘Equality’ and ‘Timeliness’ for the majority of hospitals (100% D [n=11/11] and 73% D [n=8/11]
respectively). The items ‘Privacy’ (64% C, n=7/11) and ‘Feedback’ (82% C, n=9/11) were moderately
addressed as most hospitals received a C performance level. Overall, 7 hospitals reached at least
level B for any item (64%); 5/11 were at least Level A.
No significant differences were observed in reaching a level B or A in any item between teaching vs.
general hospitals (14% vs. 5%, p=0.12).
The GRS is internationally applicable. In the Dutch setting, use of the GRS in a range of hospitals
identified relevant service gaps, in particular pertaining to monitoring of CQ items, but also in patient
experiences. The results indicate that the GRS is a useful QA tool for endoscopy, in both teaching and
general hospitals. It may guide further quality initiatives in other countries as well.