In 2017, the BSG/AUGIS guidance for upper GI endoscopy was published. This includes a recommendation of an annual minimum of 100 upper GI endoscopies per operator.
Services should consider the following:
- The recommendation of 100 upper GI endoscopies is described in the guidance as based on weak evidence and as a weak recommendation.
- Some medical endoscopists performing one mixed modality endoscopy per week may not meet this standard. Such lists may occur to support OOH bleeding rotas and facilitate patients attending for both upper and lower endoscopy on the same list (ie iron deficiency fast track cancer referrals). Many of these operators are senior established consultants and it is recognised that implementation of this standard requires a period of adjustment.
- With standard single modality lists of 10 or 12 OGDs, it is possible to deliver 100 diagnostic upper GI endoscopies in either eight or 10 lists per annum (ie less than one list per month or 2.5% of a consultant’s working year).
- Maintaining quality assurance for clinical leads is an onerous task. It is easier to improve quality if the number of operators performing a modality (ie OGD) is smaller and each endoscopist does more procedures annually.
- JAG assessments ensure that quality assurance is robust and provide advice on performance management but do not performance manage directly.
JAG believes that services should strongly support the minimum (ie 100 OGD pa) for both their own governance and to meet best practice. The minimum number is per endoscopist (and not per endoscopist per site), and the National Endoscopy Database (NED) has made it easier for operators to individually establish their annual numbers when working at multiple sites.
Where individual operators do not meet this requirement, the clinical lead should provide additional quality assurance through examination of other KPIs and DOPs and through appraisal. This should feed into their annual appraisal and therefore revalidation. The nature of this support and their endorsement should be documented in the JAG audit template, requested when services undergo an accreditation assessment. JAG will indicate during assessments that this is no longer best practice and that the service needs to implement additional quality assurance measures to support both the operator and patient safety.