Quality Control in Endoscopy: Report of an International Forum held in May 1991 PDF
Preview Quality Control in Endoscopy: Report of an International Forum held in May 1991
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 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1991 Softcover reprint of the hardcover 1st edition 1991 The use of general descriptive names, registered names, trademarks, etc. in this publi cation does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Type setting: Cicero Lasersatz, 8900 Augsburg 25/3140/543210 - Printed on acid-free paper 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
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