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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 .”