Multimethod study of Endoscopic Retrograde Cholangio Pancreatography (ERCP) service delivery: stakeholder perspectives on opportunities for quality improvement

Background and aims Endoscopic Retrograde Cholangio Pancreatography (ERCP) is a technically challenging and relatively risky procedure. The British Society of Gastroenterology ERCP Endoscopy Quality Improvement Programme was established to raise ERCP quality and reduce practice variation. We examined experiences and perspectives of ERCP practitioners, nurses and patients to inform future service and quality improvement initiatives. Participants and methods A survey was sent to all UK units performing ERCP, alongside an individual survey to ERCP practitioners, examining current practice and perceived challenges in service delivery. Open-ended question responses were thematically categorised. Online workshops qualitatively explored stakeholders’ perspectives on key topics identified from the surveys. Results 170 endoscopy units completed the organisational survey (response rate=100%); 384 practitioners completed the individual survey (response rate=74%) and 10 workshops were held (15 endoscopists, 6 ERCP nurses, 6 patients who had undergone ERCP). Participants wanted to see more comprehensive and appropriately timed communication around risks, the nature of the ERCP ‘experience’ and results. Most desired greater access to general anaesthetic/deep sedation, which was considered advantageous for both patients and clinicians. Multidisciplinary team meeting arrangements varied, and solo practitioners often relied on informal networks to discuss complex cases. Many practitioners reported having insufficient time allocated for audit and feedback and training; this, alongside poor information technology and administrative systems, impacted service provision. Conclusions Eliminating variation in UK ERCP practice is likely to require financial investment and long-term systemic changes. However, findings suggest that, shorter-term, changes to departmental organisation, governance, communication and administrative processes could improve provision and patient experience.