Quality Improvement in Gastroenterology Clinical Practice

Rakhi Kheraj; Sumeet K. Tewani; Gyanprakash Ketwaroo; Daniel A. Leffler


Clin Gastroenterol Hepatol. 2012;10(12):1305-1314. 

In This Article


Meaningful QI efforts should not be seen as top-down mandates from administrative leadership, accreditation bodies, or government organizations. At the same time, all of these groups have focused significant attention and energy on QI, with the intent of improving healthcare outcomes and efficiency. Although these goals are shared by all, the means to achieve them can vary substantially, and edicts from above rarely have the effects they were designed to achieve.[91,92] To help ensure that gastroenterology practices are free to choose QI initiatives that best serve their specific patients and do not disrupt their clinical environment, it is vital that practices foster internally derived QI efforts.

As we have described (Table 2), there are many initiatives that can be considered "low-hanging fruit" and are well within the resources of nearly all practices. In private practice settings, administrative time can often be leveraged to facilitate these projects, whereas in academic settings, students, residents, and fellows (the latter now mandated by the Accreditation Council for Graduate Medical Education to complete a QI project during training) are generally eager to participate; these efforts increase their understanding of the discipline, directly affect patient care, and often lead to publishable data. In addition, a growing number of online resources provide information and resources to assist in developing QI initiatives (Table 3). In many cases, the cost of implementing these measures is modest and cost-effective, suggesting that substantial improvement is possible even in an era of diminishing reimbursement. In all settings, QI should be seen as a team effort of the practice as a whole. Individuals at all levels from senior clinicians to administrative staff should be encouraged to identify areas of potential risk. Leadership then has the responsibility to work with front-line clinicians to prioritize issues, assess feasibility, and allocate resources when necessary.

Finally, it is the common experience in healthcare, as in other industries, that the benefits of attention to QI go beyond improving patient outcomes and increasing efficiency. Adoption of fundamental principles of QI in an outpatient practice or division improves overall patient care as well as practice finance and boosts workplace satisfaction, which are outcomes we can all agree on.