PTH-010 Cecal withdrawal time: assessing standards of colonoscopy in district general hospital
Bibliographic record
Abstract
Introduction The British Society of Gastroenterology, the UK Joint Advisory Group on GI Endoscopy, and the Association of Coloproctology of Great Britain and Ireland have developed quality assurance measures and key performance indicators for the delivery of colonoscopy within the UK. However, studies have suggested that high variations in the quality of colonoscopy among different endoscopists are reflected in surrogate measures such as adenoma detection, cecal intubation rates, withdrawal times, and incidence of complications. This documents identifies the unacceptable variation in practice and measures adopted to improve quality of care. Method A prospective, observational colonoscopy practice audit was conducted of cecal withdrawal time at Glangwili General Hospital, Carmarthem for patients who presented for colonoscopy between August 2017 to January 2018. Diagnostic procedures were included in the study comprising two cycles 8 months apart. Patients with history of colonic surgery were eliminated. Same endoscopy nurse manually collected the data from 5 different endoscopist using stopwatch without them knowing. Both the cycles were 3 months apart during which different measures were taken to improve withdrawal time including sending individual feedback to endoscopists, one to one discussions between endoscopy consultant lead and involved endoscopist and keeping a timer in endoscopy room to keep tract of time. Results We reviewed 10 colonoscopies performed by each endoscopist in each cycle of audit and mean cecal withdrawal time is shown below. After taking appropriate measure to improve quality of care following results were obtained. Following graph shows variation in mean withdrawal time between two cycles compared against set standards. Below shows the comparison of 1 st and 2nd cycle showing rectal retroflexion performed and imaging of cecal landmarks recording done by each endoscopist Conclusion Practice among endoscopists varied with majority providing good standard of care. Weak points identified during 1 st stem of audit cycle and changes implemented lead to improvement in quality of care but still there is further room for improvement. Regular audits are important to make sure that colonoscopy practice meets key performance indicators outlined by JAG and BSG in order to increase polyp detection rate. References 1. UK key performance indicators and quality assurance standards for colonoscopy -the British Society of Gastroenterology, the Joint Advisory Group on GI Endoscopy, the Association of Coloproctology of Great Britain and Ireland. 2. Point-of-care, peer-comparator colonoscopy practice audit: The Canadian Association of Gastroenterology Quality Program – Endoscopy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.032 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".