Performance measure	We recommend endoscopy services have policies and processes in place to assess the appropriateness of procedures against guidelines and take action when endoscopic procedures have been performed inappropriately
Domain	Appropriateness
Category	Process
Rationale	Having methods in place to check compliance with guidelines reduces risks to patients and ensures resources are used appropriately; at the very least, referrals from non-GI specialists should be
	reviewed, and some services may choose to review referrals from GI specialists to reassure payers that their resources are being used appropriately as there is considerable evidence that GI specialists fail to follow either upper or lower endoscopy surveillance guidelines, meaning a strong case can be made for always reviewing surveillance decisions It is noted that there are sometimes very good reasons to perform procedures outside of published guidelines, in which case the reasons should be made explicit in the patient record – if for no other reason than to protect the referrer in the event something goes wrong – and any review of referrals outside of guidelines should take exceptional circumstances into account For some situations, such as intervals to next surveillance procedure, decisions should only rarely fall outside the guidelines; however, failure to comply with guidelines in this situation is more likely to have resource implications than put patients at risk, whereas failure to adhere to guidelines for high-risk procedures, or for patients at high risk, may put patients in jeopardy Auditing adherence to guidelines is a time-consuming process and services should prioritize this activity based on impact on resources and risk
Standards	Minimum standard: defined criteria and processes on how compliance with guidelines is assessed, including prioritization of the assessment of compliance that is based on risk to patients and resources Target standard: compliance with guidelines is assessed according to processes defined in the minimum standard of Performance measure 5.2
Consensus agreement	Consensus: 81.48% (1 disagree, 4 undecided)
PICO	Not applicable
Concordance with other guidelines	ASGE Yes	Canada Yes	EU Yes	GRS/JAG accreditation Yes
Evidence grading	Moderate to very low