Since a couple of years, quality assurance (QA) stands at the core of the attention in the
healthcare sector. Especially after the publication in 2000 of the Institute of Medicine’s report
‘To err is human’ the interest in QA has taken a quantum leap and many quality initiatives have
been developed. This report revealed that every year in the United States approximately
98,000 patients died because of medical errors. Following this report, within the healthcare
sector the awareness arose that the quality of the service had to improve, with special attention
to safety and patient experiences. Since then the healthcare sector has learned some
important lessons in QA from other industries such as the airline industry and energy sector,
which are generally classified as ultra-safe organizations.
Gastrointestinal endoscopy has been one of the medicine specialties which enrolled
important quality initiatives. Especially since the introduction of colorectal cancer (CRC)
screening programs, many efforts have been undertaken to better understand the concept
of high quality endoscopy. CRC screening has been proven to decrease the incidence of CRC,
and CRC related mortality. Therefore many institutions and societies recommend to screen
asymptomatic individuals by fecal occult blood tests, flexible sigmoidoscopy, or colonoscopy.
As these screening programs involve healthy individuals, the cost-effectiveness of such
programmatic screening approaches is highly dependent on the quality of the procedure,
but also on pre- and post-procedure quality aspects to improve screenee experiences and
thereby the uptake of and adherence to screening modalities.
In the Netherlands, CRC screening is about to start in 2013 by means of biennial fecal immunochemical
testing. To attain the highest effect a comprehensive QA program should be
enrolled with major focus on endoscopy as secondary screening method, as is recommended
now by the European Union. The other diagnostic and therapeutic services provided by the
endoscopy units will benefit simultaneously from such an initiative.
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