Quality Assurance (QA) is a way of maintaining a high quality of health care services by constantly measuring the outcome of clinical practice. QA is becoming increasingly important in health care. Nevertheless, there are no specific quality requirements for colposcopy and colposcopy-guided treatments in Switzerland and many other European countries. The European Federation of Colposcopy (EFC) conducted a five-round Delphi consultation to define six quality indicators for colposcopic practice. These indicators were slightly adapted at the EFC general meeting in Paris in January 2017.
We retrospectively evaluated these quality indicators in our colposcopy clinic during the period from January 2015 to December 2016. The six indicators and corresponding targets are (1) documentation of the transformation zone type (100%); (2) percentage of cases having a colposcopic examination prior to treatment for abnormal cervical cytology (100%); (3) percentage of conisations (diagnostic or therapeutic biopsies) with cervical intraepithelial neoplasia (CIN) 2+ (≥85%); (4) percentage of excised lesions with clear margins (≥80%); (5) number of colposcopies personally performed each year with low grade/minor changes (≥50); and (6) high-grade/major lesions (≥50).
From January 2015 to December 2016, 148 conisations were performed at our colposcopy clinic. The transformation zone type was documented in nearly every colposcopy (99.3%, 147/148). 99.3% (147/148) had a colposcopic examination prior to treatment for abnormal cervical cytology and 87.3% (130/148) of conisations showed CIN 2+ in diagnostic or therapeutic biopsies. 43.2% (64/148) of excised lesions had clear conisation margins. Each colposcopist at our clinic performed more than 50 colposcopies with low grade/minor changes and high-grade/major lesions per year.
Adopting the quality indicators recommended by the EFC offers the possibility to evaluate the performance of colposcopists and provide a benchmark system to secure performance both nationally and internationally. By applying these quality indicators to our retrospective data, we identified our strengths and weaknesses, which will enable us to make future improvements in the care of our patients.
Moss EL, et al., European Federation of Colposcopy quality standards Delphi consultation. Eur J Obstet Gynecol Reprod Biol. 2013