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Paediatric Endoscopy Global Rating Scale

Development of a Quality Improvement Tool and Results of a National Pilot

Narula, Priya*; Broughton, Raphael; Howarth, Lucy; Piggott, Anna§; Bremner, Ronald||; Tzivinikos, Christos; Gillett, Peter#; Henderson, Paul#; Rawat, David**; Cullen, Mick††; Loganathan, Sabari‡‡; Devadason, David‡‡; Afzal, Nadeem A.††; Maginnis, Janis§; McKenna, Sharon*; Thomson, Mike*; Green, John§§; Johnston, Debbie

Journal of Pediatric Gastroenterology and Nutrition: April 1, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002355
Original Article: Gastroenterology: PDF Only

Introduction and Objectives: The endoscopy Global Rating Scale (GRS) is a web-based self-assessment quality improvement (QI) tool that provides a framework for service improvement. Widespread use of the GRS in adult endoscopy services in the United Kingdom (UK) has led to a demonstrable improvement in quality. The adult GRS is not directly applicable to paediatric endoscopy services. The objective of this study is to develop and pilot a paediatric endoscopy Global Rating Scale (P-GRS) as a QI tool.

Methods: Members of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Endoscopy Working Group collaborated with the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) to develop the P-GRS. After a period of consultation, this was piloted nationally at 9 centres and data were collected prospectively at 2 census points, May and December 2016.

Results: The P-GRS mirrors the adult GRS by dividing care into 4 domains and includes 19 standards with several measures that underpin the standards. Eight services completed the online P-GRS return in May 2016 and 6 in December 2016. All pilot sites identified areas that needed improvement and post-pilot reflected on the key challenges and developments. Several positive developments were reported by the pilot sites.

Conclusions: The national pilot helped ensure that the P-GRS developed was relevant to the paediatric endoscopy services. The pilot demonstrated that even in the first year of engaging with this QI tool, services were starting to identify areas that needed improvement, share best practice documents, put in place QI plans, and support greater patient involvement in services.

*Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust. Sheffield

Joint Advisory Group, Royal College of Physicians, London

Department of Paediatric Gastroenterology, Oxford University Hospitals NHS Trust, Oxford

§Department of Paediatric Gastroenterology, University Hospitals of North Midlands NHS Trust, North Midlands

||Department of Paediatric Gastroenterology, Birmingham Women's and Children's NHS Foundation Hospital, Birmingham

Department of Paediatric Gastroenterology, Alder Hey Children's NHS Foundation Trust, Liverpool

#Department of Paediatric Gastroenterology, Royal Hospital for Sick Children Edinburgh NHS Lothian, Edinburgh

**Department of Paediatric Gastroenterology, Barts Health NHS Trust, London

††Department of Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton

‡‡Department of Paediatric Gastroenterology, Nottingham University Hospitals NHS Trust, Nottingham

§§Department of Gastroenterology, Cardiff and Vale University Health Board, Cardiff, UK.

Address correspondence and reprint requests to Priya Narula, Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, UK (e-mail:

Received 2 October, 2018

Accepted 16 February, 2019

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The authors report no conflicts of interest and there are no funding sources.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,