Implementation of an intervention bundle leads to quality improvement in ulcerative colitis endoscopy reporting

Abstract

Background Accurate and detailed endoscopy reporting in ulcerative colitis (UC) is critical for clinical decision-making. High-quality reporting involves inclusion of several criteria, previously identified by an independent group of experts (Building Research in IBD Globally (BRIDGe) group). Few studies have evaluated UC reporting quality. Our aim was to evaluate the impact of an intervention bundle designed to standardise and improve UC endoscopy reporting. Methods This intervention bundle included: integration of a template into reporting software; endoscopist training; instructional posters in endoscopy rooms; cohorting patients onto specific lists. Reporting quality was judged against 10 criteria recommended by BRIDGe. In phase one, UC endoscopy reports were retrospectively evaluated at a centre with prior implementation of the intervention bundle and compared to six centres without. In phase two, the intervention bundle was prospectively implemented and evaluated at a single centre. Results In phase one, the intervention was associated with greater inclusion of BRIDGe reporting criteria from median 5 (IQR 5-7) to 7 (5-8), P < 0.0001. This was replicated in phase two, with improved reporting after the intervention from 5 (4-6) to 6 (5-8), P < 0.0001. Reporting of endoscopic indices was more frequent in the centre with prior intervention (77.7% (202/260) vs 44.4% (400/900), OR 4.35 95%CI 3.16-6.00, P < 0.0001). In phase two, implementation of the bundle increased the use of endoscopic indices pre-intervention vs post-intervention (57.7% (131/190) vs 69.6% (117/168), OR 1.68 95%CI 1.1-2.56, P = 0.02). Conclusion This is the first study to demonstrate that an intervention bundle can achieve greater standardisation and improve UC endoscopy reporting.