A Quality Improvement Initiative Results in Improved Rates of Timely Postvariceal Bleeding Surveillance Endoscopy

Abstract

Objectives: We performed a study to assess the effects of a quality improvement (QI) initiative on the rates of postvariceal bleeding surveillance upper endoscopy (EGD).

Methods: We identified patients with cirrhosis hospitalized with variceal bleeding and assessed the rates of timely (≤4 weeks) EGD before and after a QI initiative.

Results: Preintervention: 16% (5 of 32) of patients underwent timely surveillance EGD. We developed a standardized ordering template for gastroenterology fellows and reserved postvariceal EGD scheduling slots. Postintervention: 43% (12 of 28) of patients underwent timely surveillance EGD.

Discussion: A QI intervention was associated with a 27% absolute increase in timely surveillance EGDs.

Figure 1.. Fishbone diagram outlining potential causes of low rates of post-variceal bleeding surveillance EGDs

Diagram outlines the potential contributing causes for failure of patients to receive timely post-variceal bleed surveillance EGD. Each potential contributing cause is organized within categories including environment, place, policy, and people (patient and medical professional). Potential procedure and equipment issues were explored but none were identified as proximate causes.

Figure 2.. Flow chart of provision of surveillance EGD among patients hospitalized for variceal bleeding in the control and post-intervention periods

In the control period, 40 patients were considered for analysis and, after exclusions, 32 were included in the analysis. Due to failure to order or schedule EGD, late scheduling, cancelations and no-shows, 27 did not receive timely EGDs. In the post-intervention period, 38 patients were considered and 28 were included in the analysis. Overall, 16 of 28 patients did not receive timely EGDs because they were not ordered, scheduled late or canceled.