Establishing a benchmark for patient comfort during colonoscopy and esophagogastroduodenoscopy using the St. Paul's Endoscopic Comfort Scale (SPECS).

Background and study aims: Patient comfort during endoscopy is an important performance measure. However, performance benchmarks for patient comfort have not been established. The aim of this study is to establish benchmarks for patient comfort during colonoscopy and esophagogastroduodenoscopy (EGD) using the St. Paul's Endoscopic Comfort Scale (SPECS). Patients and methods: Patient, nurse, and physician focus groups were conducted to establish an acceptable threshold of comfort using SPECS. SPECS for colonoscopy and EGD at St. Paul's Hospital from January 1, 2021, to December 31, 2023, were collected. Using the SPECS threshold, we calculated benchmarks using 3 approaches: (1) 75th percentile, (2) the mean of the top 25% of physicians, and (3) Achievable Benchmark of Care (ABC), which adjusts performance for procedural volume. Results: Four patients, 6 endoscopy nurses, and 10 physicians participated in separate focus groups: a SPECS ≤ 3 was the comfort threshold determined. SPECS from 17 405 colonoscopies conducted by 18 physicians and 6180 EGDs performed by 13 physicians were used to calculate a benchmark for patient comfort. Using the 75th percentile approach, the benchmark was 96.3% of colonoscopies and 95.9% of EGDs. The mean proportion of comfortable colonoscopies and EGDs among the top 25% of endoscopists was 96.8% and 96.8%, respectively. The ABC benchmark values were 97.1% for colonoscopy and 96.9% for EGD. Conclusion: SPECS of ≤3 is an acceptable level of comfort. All 3 benchmarking methods generated comparable results, suggesting that physicians should aim for 96% of their procedures have a SPECS ≤3.