Quality in the ambulatory endoscopy center

Quality improvement (QI) activities are now key pursuits for clinicians and managers in all medical environments. Demonstration of QI effort is required for accreditation of facilities and board recertification of most medical professionals. Every facility has opportunities for improvement and the most pressing issues are often unique to the local facility. Nevertheless, to limit risks both for the health of the practice and for patients, all endoscopy facilities should ensure satisfactory performance in regard to procedural quality, infection control, equipment reprocessing, sedation and analgesia, and management of pre- and postprocedure medications, including anticoagulants and antibiotics. Because efforts are usually constrained by staff, time, and financial considerations, improvement needs must be prioritized to identify those with the greatest urgency and impact. For units new to QI endeavors, it is useful to focus on single issues at first. Improvement methods are widely varied; many are commonly applied systematically, whereas others are particularly suitable for ad hoc application. This article reviews principles pertaining to defining and selecting improvement goals and the various methodologies often employed in pursuing them. Further reading is encouraged in regard to specific methods for use by improvement teams.