outcome data and adverse event rates and evidence of engagement in educational and clinical activities with a focus on continuous quality improvement [4]. There are unlikely to be opportunities to directly observe practice for independent endoscopists and therefore quality assurance is dependent on surrogates of performance such as KPIs. Upskilling and maintenance of competence for practicing endoscopists should be directed at technical (motor skills), cognitive (knowledge and recognition), and integrative skills, such as leadership and communication [5].
There is little in the pediatric literature on quality indicators or auditable KPIs tailored to pediatric endoscopy practice which can form the foundation of quality assured practice and can then be linked to a process that ensures accountability and improves and maintains professional standards of pediatric endoscopists. Auditing against an agreed set of KPIs and reviewing practice can help reduce variation in practice and standards between individual endoscopists and units.
The successful national pilot of a pediatric endoscopy Global Rating Scale (GRS) in the UK [6] is the first step towards a pediatric endoscopy quality improvement (QI) tool. Regular engagement with a QI tool like the P‐GRS will help embed measures included in this tool, such as regular review of auditable outcomes and quality standards for individual endoscopists, use of electronic endoscopy reporting systems to capture immediate procedural and performance data to inform individual endoscopist appraisal and professional revalidation requirements and help identify areas for any development, recording and reviewing adverse events with appropriate actions undertaken, etc. in clinical practice. In time, this will lead to a systematic approach to quality assurance.
There is likely to be scepticism about such processes and practical difficulties around resources but experience with medical revalidation in the UK suggests that normalization and familiarization with the process and the acknowledgment and experience of the benefits gradually help embed the process [7].
A formal process of certification and assessment of competence has been adopted for pediatric endoscopists (www.thejag.org.uk) but there remains a need to develop a robust and clear process for monitoring of KPIs relevant to pediatric practice, thus ensuring performance of a high‐quality endoscopic examination and maintenance of endoscopic proficiency. Such processes are likely to drive up clinical standards and ensure all services provide high‐quality and safe pediatric endoscopy care.
See companion website for videos relating to this chapter topic: www.wiley.com/go/gershman3e
REFERENCES
1 1 Tazzyman A, Feguson J, Walshe K, et al. The evolving purposes of medical revalidation in the United Kingdom: a qualitative study of professional and regulatory narratives. Acad Med 2018, 93, 642–647.
2 2 Archer J, de Bere SR. The United Kingdom’s experience with and future plans for revalidation. J Contin Educ Health Professions 2013, 33(1), S48–53.
3 3 Rizk MK, Sawhney MS, Cohen J, et al. Quality indicators in gastrointestinal endoscopy. Gastrointest Endosc 2015, 81(1), 1–16.
4 4 Faulx AL, Lightdale JR, Acosta RD, et al. Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy. Gastrointest Endosc 2017, 85(2), 273–281.
5 5 Dube C, Rostom A. Acquiring and maintaining competence in gastrointestinal endoscopy. Best Pract Res Clin Gastroenterol 2016, 30, 339–347.
6 6 Narula P, Broughton R, Bremner R, et al. Development of a paediatric endoscopy global rating scale: results of a national pilot. J Pediatr Gastroenterol Nutr 2017, 64, 25–26.
7 7 Tazzyman A, Ferguson J, Hillier C, et al. The implementation of medical revalidation: an assessment using normalisation process theory. BMC Health Serv Res 2017, 17, 749.
7 The role of the Global Rating Scale in pediatric endoscopy
Priya Narula and Mike Thomson
The whole patient/family journey contributes to the excellence of a pediatric endoscopy and is not limited to the simple technical excellence of the procedure.
The Global Rating Scale (GRS) is a web‐based, self‐assessment quality improvement tool, that enables units to assess how well they provide a patient‐centered service, track their progress during quality improvement, and drive changes.
A pediatric‐specific GRS is now available.
Introduction
Variability in the quality, safety, and patient experience in endoscopy is well recognized and therefore quality assurance programs that have the potential to assess all aspects of care and support safe and high‐quality patient‐centered care are important. Even if a patient has a procedure which is technically excellent, adverse experiences such as poor communication can negatively influence patient experience and therefore there is a need for a holistic assessment. Whilst quality improvement is a process based upon cycles of measuring, planning, implementing, and further measuring, quality assurance is a process that ensures a predetermined set of standards is achieved.
The Global Rating Scale (GRS) is a web‐based, self‐assessment quality improvement tool, that enables units to assess how well they provide a patient‐centered service, track their progress during quality improvement, and drive changes. The GRS was initially developed and implemented in the adult endoscopy services in England in 2004. Adult experience demonstrated that although adult endoscopy services were encouraged to generate a continuous quality improvement cycle, it was insufficient to achieve sustained results. Quality assurance via the professionally led peer‐reviewed accreditation process helped achieve the stepwise change in quality of endoscopy care [1,2]. All adult endoscopy units in the UK currently complete the GRS online census twice a year and after a unit achieves the required levels across all items, it can apply for accreditation.
Internationally, the GRS has been shown to be applicable in Dutch adult endoscopy units [3] and has been adapted for use in Canadian adult endoscopy units [4]. A Scottish study conducted focus groups with patients and concluded that the GRS did address quality issues that mattered to patients undergoing endoscopy and validated its use as a quality assessment tool [5].
However, it is evident that the adult GRS is not applicable to pediatric endoscopy services and there has been a need for a pediatric‐relevant and ‐applicable GRS.
Pediatric endoscopy GRS
The British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) and Royal College of Physicians of London (RCP) collaborated to develop a pediatric GRS by adapting the established adult framework. This was successfully piloted nationally and ensured that the standards and measures were relevant to pediatric endoscopy services and fit for purpose [6].
The pediatric GRS provides a holistic assessment and consists of four domains, each of which refers to a broad aspect of care (Table 7.1): clinical quality, quality of patient experience, workforce, and training. Each domain is composed of qualitatively different items or standards covering all the aspects of endoscopy delivery and no standard is more or less
