Quality improvement (QI) in gastroenterology (GI), is a phrase that is often uttered in conferences, meetings, and on societal websites. It’s a concept that gastroenterologists know is important, but formal training in QI initiatives is not standardized across GI fellowships or practices. Approximately 40-50% of gastroenterologists participate in QI projects nationally. 1 Ways to improve patient care and safety are regularly apparent in clinical practice; however, knowing how to start is usually the rate limiting step. This article will provide a guide on how to select and implement effective QI projects in one’s GI practice.
What is quality improvement?
Before selecting a project, it is important to clearly define and understand the characteristics that make up a successful QI project. QI is simply defined as a process to improve a healthcare outcome.2 A framework used to initiate a QI project is the Plan, Do, Study, Act (PDSA) model. 3 For example, a common QI initiative implemented in GI is improving adenoma detection rates. If adenoma detection rates do not meet national standards, then developing a “plan” to improve detection rates is the first step. The plan can involve using artificial intelligence or a remediation program for those clinicians in the practice who do not meet national standards. The “do” stage involves implementing the strategy to impact change, and finally the “study” phase involves analyzing the date to determine whether the strategy that was implement was impactful. If impactful, then practices may “act” on these results and implement them for future use.
What is considered a “good” QI project?
A QI project should focus on a specific goal and, to be effective, it should employ the SMART framework --- specific, measurable, achievable, relevant, and time-bound.4 This means that a project should focus on a specific problem that can be measured or assessed over time. In addition, it must have realistic and practical outcomes to improve patient care and should have an achievable time frame to completion. This framework helps clarify what makes a suitable QI project, but how are opportunities for QI projects identified? A simple way to identify projects is to reflect on aspects that are deficient in a clinical practice. A common clinical deficiency is slow endoscopy turnover time. Other strategies to identify areas that could benefit from QI include patient feedback, adverse events, and quality indicators published in societal guidelines. Examples of quality improvement projects include pathology specimen reconciliation, reducing biohazardous waste, and improving quality of bowel preparations.5
Starting a QI project
The most important aspect to starting a QI project is prioritizing the needs of the clinical practice. It is vital to ask whether a project will have a meaningful impact in a particular practice setting. For example, improving patient turnover time may be more relevant in an academic center as opposed to a private practice setting where turnover times are already efficient. Other important considerations include the frequency of a reported problem by patients to justify the effort, the feasibility of conducting a project, and alignment with institutional goals. Re-inventing the wheel and trying to come up with novel ideas for QI projects is not necessary. Implementing projects that have already been conducted is not frowned upon but, rather, encouraged. It is best to start with projects that would have the highest impact and lowest to moderate effort. In other words, starting with projects where data is easily accessible and attainable is usually best. Lastly, it is important to engage the endoscopy staff in QI efforts to create enthusiasm and foster collaboration for new projects.
Conclusion
The first step to executing a QI project is identifying a project that is feasible, practical, and applicable. Using a framework to both identify and implement a clinically relevant QI initiative is essential to creating an impactful project. Although implementing a QI project can be challenging and dauting, it can have an impact on patient care and the GI community. It is important to start off with small attainable goals, as small victories in research can go a long way to building momentum, ultimately creating a positive impact on the quality of care for our patients.
References:
- American Society for Gastrointestinal Endoscopy. (2018). 2018 practice operations survey report. American Society for Gastrointestinal Endoscopy. /home/practice-support/practice-operations-survey
- Simons, J. P. (2017). What is quality improvement? Archives of Disease in Childhood: Education and Practice Edition, 102(3), 159–165.
- Institute for Healthcare Improvement. (2020). Science of improvement: How to improve.https://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx
- Institute for Healthcare Improvement. (2020). Science of improvement: Setting aims.https://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementSettingAims.aspx
- American Society for Gastrointestinal Endoscopy. (2025). Endoscopy unit recognition program (EURP) blog. ASGE. /home/resources/key-resources/blog/eurp
Authors
Nati Zilberstein, MD, MSc is an advanced endoscopist and Assistant Professor of Medicine at Harbor University of California, Los Angeles. Dr. Zilberstein is a member of the Ã÷ÐÇÂãÕÕQuality Assurance in Endoscopy Committee.
Shaun Torkan, MD is a resident physician at The University of California, San Francisco Saint Mary's Hospital.