Quality Control in Endoscopy: Report of an International Forum held in May 1991

109 Pages·1991·6.521 MB·English

by  Professor James Whitwam (auth.), Dr. Rory McCloy BSc MD FRGS, Anne Pringle Davies BSc (eds.)

Rory McCloy (Ed.)
Quality Control
in Endoscopy
Report of an International Forum held
in May 1991
Contributors
James Whitwam· Eran Geller· Emmet Keeffe
David Fleischer . Alan Maynard . Nicola Davies
David Poswillo CBE
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Budapest
Dr. Rory McCloy BSc MD FRGS
University Department of Surgery
Manchester Royal Infirmary
Manchester M13 9WL
United Kingdom
Editorial Co-ordinator
Anne Pringle Davies BSc
This International Forum was funded by an educational grant from
F Hoffmann-La Roche Ltd, Basle, Switzerland
ISBN-13:978-3-642-77140-8 e-ISBN-13:978-3-642-77138-5
DOl: 10.1007/978-3-642-77138-5
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© Springer-Verlag Berlin Heidelberg 1991
Softcover reprint of the hardcover 1st edition 1991
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Contents
Forum President VII
Editor's Preface. IX
Section 1 - Drugs for Sedation
Chapter 1 . Drugs for Sedation
J. G. WHITWAM .•..•••••. 3
Chapter 2 . Report of Workshop on Drugs for Sedation
E. GELLER ....................... . 22
Section 2 - Procedural Safety
Chapter 3 . Endoscopic Procedural Safety
E. B. KEEFFE ............... . 33
Chapter 4 . Report of Workshop on Procedural Safety
D. FLEISCHER. . . . . . . . . . . . . . . . . . . . . . 46
Section 3 - Resource Management
Chapter 5 . Economic Aspects of Endoscopy
A. MAYNARD ..•....•.•..••..• 55
Chapter 6· Report of Resource Management Workshop
A. MAYNARD ....•..•.•...•..•....••• 67
VI Contents
Section 4 - Medico-legal Aspects
Chapter 7 . Medico-legal Issues in Endoscopy
N. DAVIES .................. . 93
Chapter 8 . Report of Workshop on Medico-legal Issues
D. POSWILLO . . . . . . . . . . . . . . . . . . . . . . . 100
Subject Index 105
Forum President
Dr. Rory McCloy BSc MD FRCS
Senior Lecturer and Honorary Consultant
University Department of Surgery
Manchester Royal Infirmary
Manchester
United Kingdom
Secretary of the Endoscopy Section, British Society of Gastroenterology
(BSG)
Secretary of BSG Working Party on Sedation and Monitoring for Endo
scopy
Chairman of BSG Working Party on Informed Consent for Endoscopy
Project Leader, Audits of appropriateness and adverse outcomes of upper
gastrointestinal endoscopy, a Joint Project of the Royal College of Physici
ans of London, BSG, Association of Surgeons of Great Britain and Ireland,
College of Anaesthetists, Society of Thoracic Surgeons of Great Britain and
Ireland.
Editor's Preface
Surprisingly, little attention has been paid to the broader issues of patient
care related to endoscopy. Usually, meetings and reviews concerned with
the process of endoscopy have confined themselves to specific and traditio
nal aspects, such as endoscopic techniques and applications. These areas are
well researched, widely practised and fully documented elsewhere.
An international Forum, a marketplace with the emphasis on discussion,
was conceived to embrace aspects of endoscopy which are crucial to safe
practice and consistent with quality of care for our patients.
Unlike traditional symposia where pundits lecture to relatively passive
audiences, the Forum created an open environment where information and
opinions were shared. All the delegates were active participants and selected
from 17 countries for their knowledge and expertise in endoscopy and
related disciplines.
It may seem unusual at a meeting on Quality Control in Endoscopy that
only three members of the faculty were practising endoscopists. Since we
were discussing four main areas - drugs for sedation, procedural safety,
resource management and medico-legal aspects, specialists in each of these
fields were invited to contribute their particular expertise and apply it to the
topic under discussion, endoscopy.
The innovative format of the Forum, which met in May 1991, deserves an
explanation. The meeting was divided into three parts. The opening session
consisted of keynote lectures on each of four main topics.
The Forum then divided into simultaneous workshops dealing with each
of these areas. In the Workshops dealing with Drugs for Sedation and
Procedural Safety, the participants had each been pre-assigned a topic.
Their preparation prior to the event enabled them to act as lead-off discus
sants on these topics within the Workshops. Forty eight participants contri
buted to fourteen hours of in-depth discussion within the Workshops.
Participants in the Workshop on Resource Management were sent a
questionnaire dealing with staff, drugs, consumables, equipment and over
heads - the main cost components of endoscopy. The results from these
highlighted many of the problems of trying to apply health economics to a
specific area in which data are lacking.
For the Medico-legal Workshop, two legal cases were devised. Delegates
in this Workshop were asked to prepare themselves to act as expert medical
witnesses in defence or prosecution of the endoscopist on trial. Discussions
X Editor's Preface
arising from this covered the principal issues of negligence and informed
consent.
Each of the four Workshop Directors then presented a summary of their
Workshop discussions, conclusions and recommendations at a final plenary
session.
This publication presents the four keynote lectures and their complemen
tary Workshop Reports, combined to form a unique overview of quality
control in endoscopy.
RORY MCCLOY
University of Manchester
September 1991
Section 1: Drugs for Sedation
Keynote Lecturer
Professor JAMES WHITWAM MB ChB PhD FRCP FFARCS
Director of Anaesthetics
Royal Postgraduate Medical School
Hammersmith Hospital
London
United Kingdom
Workshop Director
Professor ERAN GELLER MSc MD
Director Department of Anesthesiology and Critical Care Medicine
Tel Aviv Medical Center
and
Associate Professor of Anesthesiology
Chairman, Division of Anesthesiology
Sackler Faculty of Medicine
Tel Aviv University
Tel Aviv
Israel
Workshop Participants
Dr. J. R. ARMEGOL MIRo, Barcelona, Spain
Professor R. ARNOLD, Marburg, Gemany
Dr. J. F. W. BARTELSMAN, Amsterdam, The Netherlands
Dr. K. BAUCH, Chemnitz, Germany
Dr. F. EIGENMANN, Berne, Switzerland
Dr. A. GEVERS, Leuven, Belgium
Dr. B. HOFFSTAD, Oslo, Norway
Dr. E. K. JANATUINEN, Kuopio, Finland
Mr. P. N. J. LANGENDIJK, Amsterdam, The Netherlands
Dr. A. MALDONADO, Lisbon, Portugal
Dr. R. PEARSON, Manchester, United Kingdom
2 Section 1: Drugs for Sedation
Dr. F. SERVIN, Paris, France
Dr. M. VAN BLANKENSTEIN, Rotterdam, The Netherlands
Dr. S. D. J. VAN DER WERFF, The Hague, The Netherlands
Dr. F. VICARI, Nancy, France