PTH-162 The Challenges of Implementing Evidence into Endoscopic Practice: A Qualitative Study

Abstract

INTRODUCTION: The Quality Improvement in Colonoscopy (QIC) study was a region wide service improvement study that aimed to improve adenoma detection rate (ADR) by implementation of measures into routine colonoscopy practice. They were: withdrawal time of ≥ 6 minutes; hyoscine butylbromide use; supine position for examination of the transverse colon; rectal retroflexion. Each has been shown to improve lesion detection. The implementation of evidence into clinical practice can be challenging. AIMS&METHODS: We aimed to evaluate factors influencing implementation of the 'bundle' in the QIC study. Twelve endoscopy units participtaed who are members of the Northern Region Endoscopy Group (NREG), a clinical research network in England. The study team held training sessions at each unit to introduce the “bundle”, supported by a nominated local lead colonoscopist and nurse. Posters were supplied for each endoscopy room to aid promotion. Following study completion, units and individuals were purposively sampled for the qualitative study to ensure a range of units (by size, bundle uptake) were included. Semi-structured interviews were conducted until saturation was reached. Data were evaluated using thematic analysis to code and categorise interviews. RESULTS: 118 colonoscopists participated in the QIC study. Interviews were conducted with 11, 8 lead colonoscopists, 1 lead nurse and 3 non-lead colonoscopists. Increased emphasis on examination time, increased awareness of ADR as a quality marker and empowerment of endoscopy nurses to encourage use of quality measures were seen as positive outcomes of the study. The simple, highly visible posters were also reported as useful in aiding study promotion. Challenges included difficulty in arranging set up meetings and engaging certain speciality groups. CONCLUSION: Implementation of evidence into clinical practice can be challenging. During the QIC study, challenges included arranging staff meetings and engaging all team members. Positive outcomes included increased awareness of colonoscopy quality, particularly slower withdrawal times, and empowerment of endoscopy nurses to promote quality measures. We demonstrate that emphasis on timing of meetings and strategies to engage speciality groups should be given consideration when planning implementation of evidence or guidelines into clinical practice.