Shadi Saboori, MD, MPH
Charlotte, North Carolina
Shadi Saboori, MD, MPH1, Brittany Seminara, MD1, Mackenzie Jarvis, PA-C, DMSc2, Dawn Vickers, RN1, Teneshia Sinclair-Moore, MSN, RN1, Barbara Clark, MSN, RN3, Baha Moshiree, MD, MSc4
1Carolinas Medical Center, Charlotte, NC; 2Atrium Health, Charlotte, NC; 3Carolinas Medical Center - Mercy, Charlotte, NC; 4University of North Carolina, Charlotte, NC
Introduction: Accurate performance of esophageal manometry (EM) is essential for the diagnosis and treatment of esophageal motility disorders. The American Neurogastroenterology and Motility Society (ANMS) proposed minimal quality measures (QMs) for performance and interpretation of EM in 2017. Many community practices are not adhering to standardized guidelines. We previously assessed the compliance to ANMS QMs in terms of procedural performance guidelines and adherence to the Chicago Classification Guidelines for interpretation of studies (Seminara B et al). Our aim now is to present our post-quality improvement (QI) initiative results with respect to performance and interpretation of the EMs.
Methods: Motility Nurses were sent to the ANMS Clinical training course with additional weekly training by a GI motility physician with review of standard protocols. A procedural checklist was established and implemented for all subsequent EMs. GI physicians were provided detailed data with articles and books regarding utilizing the Chicago Classification for interpretation of EM results but did not receive 1:1 formal training. Twenty-seven EM studies conducted between January to March 2019 were reviewed since the training. Three main procedural QMs were assessed for compliance: 30 second swallows, 10 attempted wet swallows, and at least 7 evaluable swallows with solids swallows. All 27 studies previously interpreted by community GIs were reread by a motility expert and assessed for: correct diagnosis, missing items based on the Chicago Classification, treatment / referral plan, and the appropriateness of surgery referral.
Results: In all three procedural QMs, nursing compliance improved to 100% post QI initiative (n=27) (see Table 1). For the interpretation segment: 78% (n=21/27) made an incorrect diagnosis, 92% (25/27) had at least one missing item, 26% (7/27) had no treatment plan, 26% (7/27) were referred to surgery 3 of which was for an incorrect diagnosis.
Discussion: This QI initiative effectively increased compliance by nursing staff performing EM up to 100% as assessed by the ANMS validated procedural QMs. However, our study revealed poor data interpretation by physicians despite adequate performance of EMs resulting in a high degree of incorrect diagnoses and possibly treatments. Future QI initiatives should focus on formally improving physician education on the interpretation to increase diagnostic accuracy.
Seminara, Brittany V. et al., Gastroenterology, May 2019, S-147.
Citation: Shadi Saboori, MD, MPH; Brittany Seminara, MD; Mackenzie Jarvis, PA-C, DMSc; Dawn Vickers, RN; Teneshia Sinclair-Moore, MSN, RN; Barbara Clark, MSN, RN; Baha Moshiree, MD, MSc. P1182 - ASSESSMENT OF PROCEDURAL PERFORMANCE AND COMPLIANCE WITH STANDARDIZED INTERPRETATION OF HIGH RESOLUTION ESOPHAGEAL MANOMETRY STUDIES POST-QUALITY IMPROVEMENT INITIATIVE AT A LARGE COMMUNITY HOSPITAL. Program No. P1182. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.