Impact of endoscopic ultrasound quality assessment on improving endoscopic ultrasound reports and procedures

Table 2 Endoscopic ultrasonography quality indicator frequencies and comparative statistical analysis

EUS QIs	Rambam 2013-2014 EUS reports % documented (n = 200)	WJGE Lachter et al 2013 (data from 2009), EUS reports % documented (n = 100)	Improvement significance (P value)
Pre-procedural
Indications for procedure	99%	97%	NS
Detailed patient description from referring physician	100%	8%	P < 0.001
Minimum 6 h NPO	100%	40%	P < 0.001
Antibiotics per protocol prior to FNA of pancreatic cysts	99.5%	94%	P = 0.0014
Listing of anesthesia administered prior to and during EUS	100%	61%	P < 0.001
Patient signed agreement of informed consent	100%	61%	P < 0.001
Intra-procedural
Suspected pancreatic lesions should include parenchymal description of body, head, tail, and duct	95%	64%	P < 0.001
CBD and GB contents should be detailed and a description for sludge, stones or other findings	98%	0%	P < 0.001
LN detailed description as well as kidney and left liver lobe for lesions	50%	35%	P = 0.04
Celiac axis described for arterial structure along w/aorta, SMA and LNs	13%	5%	NS
Description by TNM system	100%	95%	NS
Detailing of lesions and surroundings in accordance with layers visualized by EUS	75%	65%	NS
Degree of tumor penetration into organ mucosa and surrounding structures	80%	46%	NS
Detailing presence of LN when suspicious for malignancy and when performing FNA	100%	6%	P < 0.001
Presence or absence of mechanical problems or difficulties including past abdominal surgeries or ascites	100%	2%	P < 0.001
Patient awakened or uncooperative during procedure	78%	-	-
No. of passes (FNA)	67%	-	-
Needle size	99%	-	-
No. of needles	40%	-	-
Impressions of aspirate (bloody, mucinous, color)	100%	-	-
Cytology/histology	100%	-	-
In-room tentative Dx	100%	-	-
Post-procedural
Summary of Dx	95%	37%	P < 0.001
Exam findings, even if not relevant to reason for EUS referral	100%	80%	NS
Physician recommendations with respect to exam findings	99%	52%	P < 0.001
Instructions for how patient will receive results	100%	0%	P < 0.001
Incidence of adverse events should be listed

NS: Not Significant; Dx: Diagnosis; LN: Lymph node; TNM: Tumor node metastasis; EUS: Endoscopic ultrasonography; NPO: Nil Per Os; FNA: Fine needle aspiration; CBD: Common bile duct; GB: Gallbladder; SMA: Superior mesenteric artery.