Advances in Endoscopy

ASGE's Endoscopy Unit Recognition Program

Bret T Petersen

G&H Why was the Endoscopy Unit Recognition program developed?

BP The rationale for the Endoscopy Unit Recognition program (EURP) was two-fold. First, the American Society for Gastrointestinal Endoscopy (ASGE) recognized the need to standardize and promulgate best practices, particularly with regard to infection control, to help our members ensure that the endoscopic services they deliver are the highest in quality and safety. Second, the society also sought to provide a means for gastroenterologists, endoscopists, and the units in which they work to distinguish themselves from lesser-quality services offered in varied environments by many types of practitioners.

G&H Could you discuss the requirements for certification?

BP Several requirements must be met to achieve certification in the EURP. First, endoscopy units must also be accredited, generally by either the Accreditation Association for Ambulatory Health Care (AAAHC) or the Joint Commission. Accreditation by the AAAHC tends to be more frequently sought by ambulatory surgery centers and freestanding units, where as Joint Commission accreditation is more commonly achieved by hospital-based units, but either accrediting organization can be used. The process of accreditation ensures that many varied issues pertinent to the delivery of quality care have been addressed.

Accreditation is usually granted for terms of 3 years. Second, to qualify for the EURP Award, each unit must certify that they are currently following, or instituting, specific practices and guidelines established by the ASGE pertaining to credentialing, infection control practices, and reprocessing of endoscopes. Third, a member of the management, training staff, or another physician, nurse, or administrator in a role of responsibility must attend the ASGE's course on improving quality and safety in endoscopy units. Finally, at least 50% of the endoscopists working in each recognized unit must have membership in good standing in the ASGE in order to ensure certain degrees of training and expertise among the practitioners.

G&H What are the specific benefits for endoscopy units that meet the requirements for certification?

BP There are two major benefits. First, the program prompts units to state their intention to adhere to accepted guidelines on credentialing and infection control, and it helps them ensure that they are training their staff and practicing in accord with these standards for high quality, particularly in terms of endoscope reprocessing and other infection control measures.

The second benefit of meeting the standards of the program is the recognition of being cited as an “ASGE-Recognized Unit,” which allows the use of this logo on materials such as letterheads, web sites, and endoscopy reports, and for marketing and local media purposes. We have noticed that this benefit has been of keen interest to many of the units that have applied.

G&H Do certified units have to undergo recurrent certification?

BP The EURP is designed as a 3-year award that, upon expiration, can be resubmitted for continuation. This fits well with the duration of accreditation granted from the two accrediting organizations, the Joint Commission and the AAAHC. Thus, the intent is that recertification will also require re-accreditation from these or other accrediting bodies. The specific mechanism toward recertification is still under development. We anticipate that the expanding participation and further development of program benefits will make this a clear value-added proposition, prompting recertification by most units.

G&H What has been the response to this program?

BP The response has been outstanding and has exceeded initial expectations. We have now held 4 quality courses, all of which have been fully subscribed. In fact, the first was oversubscribed and had to be divided into two separate courses. The first two courses were held in October 2008, followed by one in February 2009 and one in October 2009. The next course, scheduled for mid-December 2009, is headed toward full enrollment, as it is currently ahead of enrollment projections. Two additional courses are planned for 2010, including one slated for Chicago in late May and one on the West Coast in early December. The details for these courses are available on the society web site. The EURP has also been embraced quite rapidly. The first recognition cohort was announced at Digestive Disease Week this year, and to date more than 180 units have enrolled in the course and submitted applications for certification upon completion of the course.

G&H What topics are covered in the course on improving quality and safety in endoscopy units?

BP Specific presentations deal with the principles of quality and quality metrics, benchmarking and record keeping, informed consent and communication, efficiency, sedation monitoring, infection control, endoscope reprocessing, safe medication practices, response to suspected infection, training and credentialing in new procedures, accreditation, and design and implementation of a quality assurance program. A highly valued aspect of the course has been the use of roundtable discussions and significant question-and-answer sessions for open discussion and interchange of successful practices among the attendees.

G&H What do accreditation and certification of an endoscopy unit mean in terms of safety concerns, particularly avoidance of systemic errors?

BP We believe that accreditation and certification greatly enhance the likelihood that units will operate in accordance with established best practices and guidelines. This should significantly reduce safety concerns and reassure patients that they are not likely to be subject to systemic errors ingrained in the practice pattern of a given facility. For a certified unit, systemic errors in the performance or delivery of endoscopic care are very unlikely. Although there is no guarantee that accreditation will eliminate all safety concerns, and any unit may still be subject to singular, ad-hoc errors on any given day, these programs should reduce these risks as well.

G&H How does the EURP help minimize risk from endoscopically transmitted infections?

BP Risk minimization is achieved partly through training the trainer, or manager, for all the endoscopic units that attend. Hence, the individual responsible for the training and administration of each unit is well versed in best practices and can instill them in their local environment. A major component of infection control involves endoscope reprocessing, including adherence to specific steps and use of appropriate solutions, cleaning devices, intervals, and so on. Another major component of infection control and avoidance goes beyond actual reprocessing of soiled endoscopes to appropriate use and cleaning of other equipment, corollary devices, endoscope attachments, use of disposable versus reusable devices, plus principles of medication administration and avoidance of soiling multi-use vials. The minimization of risk boils down to appropriate training as well as the will and intent to follow accepted practices. Clusters or outbreaks of infection related to gastrointestinal endoscopy generally do not occur in units in which standard principles and practices have been rigorously followed. Rather, they have been uniformly attributed to lapses in accepted practices.

G&H How do you foresee this program evolving over the next 10 years?

BP I think that there will be further growth in the number of participating units for the foreseeable future. Considering the many settings for delivery of endoscopic services in the United States, we have only scratched the surface thus far. As the program continues to grow, and particularly as we arrive at the need for recertification procedures, our goal in the Quality Committee of the ASGE is to enhance the attractiveness of the program via additional benefits. A variety of possibilities has been discussed, but varied ongoing education and training, communication of new alerts and processes, and facilitation of communication among certified units via electronic means or national meetings are all goals that will hopefully continue to lend value to the program for units in the future.