ERCP – The Way Forward, A Standards Framework
Mark Wilkinson, (BSG Endoscopy, working party convenor and chairman) et al.
To improve the quality and availability of ERCP in the UK, a working party was set up incorporating a number of stakeholders (Appendix 3) to make recommendations to achieve this goal. The attached framework document is the output of that process. It is recognised that not all changes can be achieved immediately, but that these are the standards to be aimed for. Though regulatory frameworks differ among the 4 nations of the UK (and delegates from Scotland, Wales and Ireland were represented on the working party) it is intended that this framework will be applicable to the whole of the UK.
In brief its recommendations are:
- ERCP should only be carried out in facilities dedicated to high standards of performance and safety, as measured by key performance indicators.
- That there should be a minimum of 75 cases per annum for ERCP endoscopists, and 150 cases minimum per facility, although we should be aiming for a minimum of 100 cases and 200 cases respectively.
- That ERCP services should work collaboratively in a regional or hub-and-spoke model, with simple and rapid referral pathways established.
- That facilities for urgent or emergency ERCP should be widely available.
- That minimum standards for independent practitioners should be based on intention to treat and include a >=85% cannulation rate of virgin papillae, CBD stone clearance for >=75% of those undergoing 1st ever ERCP, and for patients with an extra-hepatic stricture, successful stenting with cytology or histology where appropriate at 1st ERCP in >=80%.
- That performance criteria should be monitored by a detailed audit and feedback process via a strengthened JAG/GRS process, and be incorporated into consultant appraisal.
- That the organisation and standards for training for ERCP should follow from the above performance criteria.
- That newly appointed consultants are mentored to ensure a safe and effective transition from trainee to independent practitioner.
- That high quality performance in ERCP service and training should support high quality research.
- There should be a national registry of ERCP cases to monitor practice and outcomes which will aid a cycle of continuous improvement and provide research data to plan better care in the future.