Award: Fellows-in-Training Award (Practice Management Category)
Nghiem B. Ha, MD, MAS, Jin Ge, MD, MBA, Jessica B. Rubin, MD, MPH, Annsa C. Huang, MD, Connie W. Wang, MD, Courtney B. Sherman, MD, Danielle Brandman, MD, MAS; University of California San Francisco, San Francisco, CA
Introduction: Esophageal variceal (EV) hemorrhage is a significant cause of morbidity and mortality in patients with cirrhosis. Though timely endoscopic follow-up for EV surveillance improves outcomes, there remains significant practice variation regarding recommended follow-up interval after variceal detection on esophagogastroduodenoscopy (EGD). In this quality improvement study, we aimed to improve adherence to EV surveillance recommendations per American Association for the Study of Liver Diseases (AASLD) and American Society for Gastrointestinal Endoscopy (ASGE) by implementing prescriptive templates in an endoscopy reporting software. Methods: A pre-post study was conducted at a single academic center between 1/2018 and 3/2020. Interventions included (1) surveying faculty/fellows to identify barriers of knowledge/adherence to guidelines, (2) disseminating uniform follow-up recommendations derived from AASLD/ASGE best practices, and (3) developing an automated prescriptive template in PENTAX endoPRO software to standardize procedural documentation and follow-up recommendations. Outcomes included adherence to standardized follow-up recommendations of (1) ≤2 years for small varices, (2) ≤3 months for medium/large varices or endoscopic variceal ligation (EVL), or (3) initiation of a non-selective beta blocker. Results: Among 2,363 EGDs performed prior to the intervention in 2018, EV were noted on 218 EGDs with the majority (54%) without documentation of EV size. Of the 127 EGDs with documented EV size and/or EVL, only 63% provided guideline-based follow-up recommendations. On the pre-intervention survey (n=24), suboptimal adherence was due to variability in provider practices with regards to follow-up intervals due to conflicting guidelines and low satisfaction rate (19%) with the current endoscopy reporting template. Development of an automated template to standardize guideline-based follow-up was implemented on 6/2019. After template implementation, the rate of adherence to guideline-based recommendations improved quarterly from a baseline of 69% to 74%, 80%, and 94%, respectively (Figure 1). Discussion: Suboptimal adherence to recommended guidelines for EV-related care was due to variability in provider practices based on differing recommendations between societal guidelines and inadequate documentation of variceal size. Our intervention utilizing standardized automated prescriptive templates in endoPRO led to improved overall adherence to guideline-based EV surveillance recommendations.
Figure 1. Compliance Rate of Esophageal Varices Surveillance Recommendations
Disclosures: Nghiem Ha indicated no relevant financial relationships. Jin Ge indicated no relevant financial relationships. Jessica Rubin indicated no relevant financial relationships. Annsa Huang indicated no relevant financial relationships. Connie Wang indicated no relevant financial relationships. Courtney Sherman indicated no relevant financial relationships. Danielle Brandman indicated no relevant financial relationships.