population of patients,"
says Dr. Keswani. "If
someone's ADR is just
10% and their peers are
at 30%, they know
there's an issue that
needs to be
addressed."
These physicians,
the outlier performers
whose ADR is less
than 20%, are the ones
to focus your efforts
on, whether it's through remediation, additional scope training or
even reassessing the privileges they're allowed to have in endoscopy.
"Getting people's ADR from 42% to 45% may have little to no effect,"
says Dr. Keswani, "but if you look at all the studies, the relative risk of
your patient developing cancer if they get scoped by a person with a
fair or a very low ADR compared to someone with a high ADR is quite
significant. It's almost 5 times higher."
2. Split-prep is the only prep.
At many facilities, split-prep
bowel treatment — taking half the prep drink the night before the
procedure and the other half the morning of (say 5 hours prior to the
colonoscopy) — is the standard. But if you're not doing split prep,
you need to start. "You need to make sure all patients coming in for a
colonoscopy are getting split-dose bowel preparations," says Dr.
Keswani. "It's another structural thing you can implement in your lab
that markedly improves the overall quality of the colonoscopy." And
this improved quality translates to higher ADR. "Using split-prep
J A N U A R Y 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 8 7
• PEER PRESSURE Semi-annual physician report cards that benchmark GI
docs to their peers with similar patient populations highlight poor performers
and boost ADRs.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
