Читать книгу Successful Training in Gastrointestinal Endoscopy - Группа авторов - Страница 57

Complications may be recognized immediately during the procedure or after the procedure has been completed. Some complications may be delayed in onset by several hours (e.g., post‐ERCP pancreatitis) or may not occur until weeks later (e.g., post‐polypectomy hemorrhage). It is the responsibility of the endoscopist and endoscopy unit to identify complications and institute proper therapy in a timely manner. Complications should be recorded and each unit should have a procedure for doing so. For some procedures, the expected frequency of complications is high enough that this may be used as a quality endpoint in and of itself (e.g., post‐ERCP pancreatitis). However, most procedures' complications are rare and therefore their occurrence, or lack of occurrence, is an unreliable marker of an individual's competency. Instead, complications should be used as a tool toward quality improvement. Complications should be regularly reviewed, such as quarterly, in a nonconfrontational forum that focuses on the educational aspects with the goal of improving the quality of care. It should be noted that quality improvement meetings, such as morbidity and mortality conferences, are protected from legal discovery should a lawsuit arise.