PAGE 32
The Culture of Different
GASTROENTEROLOGY AND GI SURGERY
Expanding the Scope of Adverse Events
Pediatric gastroenterologist Robert Kramer, MD, isn’ t satisfied with the definition of“ adverse event.”
“ The traditional view is that it’ s a defined negative outcome— bleeding, perforation, infection— and if we didn’ t have one of those events, we did okay” he says.“ That lulls us into a false sense of security.”
Endoscopy itself minimizes medical risk by replacing more invasive procedures, and Dr. Kramer has been a national leader in pushing endoscopy to do more. But any procedure comes with risk. Dr. Kramer wanted to know exactly what those risks were.
Back in 2010, Dr. Kramer started a database to track and sort every endoscopy performed at Children’ s Hospital Colorado: whether the procedures worked as intended, along with any associated morbidity and cost. He defined these events, classified them, figured out why they happened and how to avoid them. Seven years later, it’ s the largest-ever single-center, published series on the safety of GI endoscopy in children.
As the chair of the endoscopy committee within the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, he and his group recently expanded upon that work to publish definitive endoscopy quality metrics for institutions nationwide.
“ I see myself operating at the intersection of quality and intervention,” says pediatric endoscopy expert Robert Kramer, MD.“ Avoiding the procedures we don’ t need improves safety for everyone.”
“ We’ re working to improve every aspect of the endoscopy experience for kids,” says Dr. Kramer.“ That means not only ensuring these procedures are as safe as possible, but also making certain that we perform them only when absolutely indicated and most likely to make a positive impact on their care.”