Clinical key performance indicators (KPIs) relevant to individual practitioners and services, adapted Wilkinson et al 2
| Input (objective) | Output (minimum) | Output (achievable) | Evidence |
| Able to undertake common procedures to high standard | Competence in level 1 and 2 procedures plus extraction of stones >10 mm in diameter | Endoscopists who deliver regional services also competent in levels 3 and 4 procedures. | Audit/rate card |
| Able to achieve success rates that meet ‘family and friends test’ | Successful cannulation (of clinically relevant duct) in 85% of 1st ever ERCPs* CBD Stone clearance at 1st ERCP in ≥75%* 80% patients with extrahepatic stricture have stent sited and cytology or histology taken at 1st ERCP where appropriate* | Successful cannulation in ≥90% of 1st ever ERCPs CBD Stone clearance at 1st ERCP in ≥80% >85% patients with extrahepatic stricture have stent sited histopathology/cytopathology taken at first ERCP | |
| Able to perform procedure with acceptable level of risk to patient | Complication rate for level 1 and 2 procedures <6%* | ||
| Delivers ERCP as part of individualised package of care that draws on MDT | Full participation in core clinical services, including regular MDT meeting | Shares data and service developments across regional network | MDT meeting register, appraisal, network meetings |
| Has lead in educating others on role of ERCP | Trains year 1–3 trainees in indications, consent process and identification of complications | Able to deliver safe and effective hands on tuition Can undertake formative and summative assessments of ERCP trainees Able to mentor newly appointed consultants | Appraisal. Trainee feedback Evidence of participation in postgraduate and/or basic skills courses (including ‘train the trainer course’) |
*On completion of mentorship (see training). Figures based on intention to treat, after exclusion of patients with Billroth II/Roux-en-Y anatomy. For patients with suspected CBD stone successful clearance defined as empty CBD with no stent in situ at end of procedure. Siting of stent requires proximal end of prosthesis to traverse stricture and (for plastic stents) distal end to traverse papilla.
CBD, common bile duct; ERCP, Endoscopic Retrograde Cholangiopancreatography; MDT, multidisciplinary team.