Key performance measure	Patient comfort
Description	Patient comfort should be audited for all DAE procedures using a validated comfort score
Domain	Patient experience
Category	Outcome/Process
Rationale	Patient comfort is a surrogate marker for quality of the procedure. There are considerable differences among enteroscopists, equipment, techniques, and among different sedation protocols with regards to patient-reported pain and discomfort
Construct	Denominator: Patients undergoing DAE Numerator: Patients in the denominator with recorded and reported comfort score Exclusions: None Calculation: Proportion (%) Level of analysis: Service and individual level Frequency: Yearly and/or for a sample of 100 DAEs
Standards	Minimum standard: unknown Target standard: ≥90% Currently there is no gold-standard approach to measuring patient experience: different questionnaires are available and their comparative performance is unclear. Ideally, patient experience should be self-reported and/or recorded by the endoscopist/nurse using a standardized and validated reporting method. Audits should be performed both on service and individual endoscopist levels to assess patient experience In case of substandard levels, analysis of the factors influencing comfort (including assessment of operator numbers, operator experience, case complexity, and technique) should be performed on an individual and service level After evaluation and adjustment, close monitoring should be performed with a further audit within 12 months
Consensus agreement	90.9%
PICO number	21, 24 (see Supporting information, DAE file)
Evidence grading	Moderate-quality evidence