Pediatric endoscopy: how can we improve patient outcomes and ensure best practices?

ABSTRACT

Introduction

Strategies to promote high-quality endoscopy in children require consensus around pediatric-specific quality standards and indicators. Using a rigorous guideline development process, the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) was developed to support continuous quality improvement efforts within and across pediatric endoscopy services.

Areas covered

This review presents a framework, informed by the PEnQuIN guidelines, for assessing endoscopist competence, granting procedural privileges, audit and feedback, and for skill remediation, when required. As is critical for promoting quality, PEnQuIN indicators can be benchmarked at the individual endoscopist, endoscopy facility, and endoscopy community levels. Furthermore, efforts to incorporate technologies, including electronic medical records and artificial intelligence, into endoscopic quality improvement processes can aid in creation of large-scale networks to facilitate comparison and standardization of quality indicator reporting across sites.

Expert opinion

PEnQuIN quality standards and indicators provide a framework for continuous quality improvement in pediatric endoscopy, benefiting individual endoscopists, endoscopy facilities, and the broader endoscopy community. Routine and reliable measurement of data, facilitated by technology, is required to identify and drive improvements in care. Engaging all stakeholders in endoscopy quality improvement processes is crucial to enhancing patient outcomes and establishing best practices for safe, efficient, and effective pediatric endoscopic care.

KEYWORDS:

• Gastrointestinal endoscopy
• quality improvement
• endoscopy standards
• quality indicators
• benchmarking
• practice guideline
• artificial intelligence
• electronic medical record

Article highlights

• In 2022, the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) published standards, indicators, and reporting elements for high-quality pediatric endoscopy developed through an international consensus process.

• The PEnQuIN guidelines can be used as a framework for audit and feedback, quality improvement and benchmarking performance at all levels at which endoscopy services are provided.

  • Endoscopist: The ability to competently perform gastrointestinal endoscopy procedures is essential to providing high-quality endoscopy. The development and maintenance of competence should be supported by using validated assessment tools, protocols for credentialing and granting privileges to perform procedures, mechanisms for audit and feedback and strategies for remediation for underperforming endoscopists and trainees.

  • Facilities: National and international initiatives aimed at reducing variability and improving the quality of endoscopy facilities are required, with data collection ideally facilitated through electronic endoscopy reporting systems.

  • Endoscopy community: Ultimately, the goal is to improve quality within the entire endoscopy community. This can be achieved by developing large-scale pediatric endoscopy collaboratives, registries, and networks for continuous quality improvement and performance benchmarking against local, national, and international standards.

• Across all levels of endoscopy services, technological advances in electronic medical records, artificial intelligence, mobile health platforms, and video capture can facilitate quality improvement efforts.

Disclosure statement

LB Mahoney has nothing to disclose. JS Huang discloses the following: Abbvie (research), Ferring (research), Janssen (research), Takeda (research); JR Lightdale: Mead-Johnson (advisory board), Perrigo (advisory board), Sanofi (advisory board); CM Walsh holds an Early Researcher Award from the Ontario Ministry of Research and Innovation. The funders had no role in the design and conduct of the review, decision to publish and preparation, review, or approval of the manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.