BMJ  2006;332:1320-1323 (3 June), doi:10.1136/bmj.332.7553.1320

Practice

Quality improvement report

Improving surveillance for Barrett's oesophagus

Peter A Bampton, head of gastrointestinal endoscopy1, Anne Schloithe, technical officer2, Jeff Bull, clinical nurse4, Robert J Fraser, associate professor5, Rob T A Padbury, divisional director3, David I Watson, professor2

1 Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, SA 5042, Australia, 2 Department of Surgery, Flinders University of South Australia, Bedford Park, 3 Division of Surgery and Specialty Services, Flinders Medical Centre, 4 Investigations and Procedure Unit, Repatriation General Hospital, Daw Park, SA 5042, Australia, 5 Department of Gastroenterology, Repatriation General Hospital

Correspondence to: P Bampton Peter.bampton{at}flinders.edu.au

Abstract

Problem A retrospective audit of surveillance for Barrett's oesophagus 1996-2001 identified the need to improve adherence to guidelines for the endoscopic surveillance of patients with Barrett's oesophagus.

Design Prospective audit of the effect of disseminating guidelines in 2002. Prospective audit of the effect of introducing local guidelines and Barrett's oesophagus surveillance officers, 2003-2005.

Setting Two general hospitals in Australia, 2002-5. All adult patients diagnosed with Barrett's oesophagus were included.

Key measures for improvement Proportions of patients in a Barrett's oesophagus surveillance programme who had appropriate time intervals between follow-up endoscopies and who had appropriate numbers of biopsies collected at endoscopy.

Strategies for change Local guidelines were laid down. Surveillance coordinators for Barrett's oesophagus were introduced to manage the process according to a clinical protocol designed for each patient.

Effects of change Disseminating guidelines had little effect on practice. Six months after surveillance coordinators were introduced, adherence to the planned surveillance interval increased from 17% to 92% and the number of endoscopies at which sufficient biopsies were collected increased from 45% to 83%. These changes have been maintained.

Lessons learnt Disseminating guidelines and results of an audit on endoscopic surveillance in Barrett's oesophagus had no effect on practice. Introducing coordinators who proactively managed the process greatly improved adherence to guidelines.


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