Center of Excellence in Endoscopy

In partnership with key opinion leaders and industry professionals, SRC developed the Center of Excellence in Endoscopy (COEE) program. The COEE program identifies endoscopists and facilities that provide excellent endoscopic care and are dedicated to continuously improving healthcare quality and patient safety.

The COEE program addresses issues facing the specialty, including:

  • Difficulty in identifying excellence for patients and referring physicians
  • The need to control care provider costs and outcomes (including reimbursement and malpractice rates)
  • Use of outdated procedures
  • The need to establish universal standards to measure program performance
  • Lack of a central outcomes database

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Program Requirements

Requirement 1: Institutional Commitment to Excellence

The applicant facility demonstrates a commitment to excellence in gastroenterology and endoscopy from the highest levels of its medical staff and administration.

This commitment includes having specialty-specific credentialing and privileging guidelines in gastroenterology and endoscopy.

Requirement 2: Endoscopic Experience

The applicant facility performs at least 500 endoscopic procedures annually.

Each endoscopist has served as the primary endoscopist for at least the minimum in each of the procedures listed below annually and in their lifetime.

Endoscopist Lifetime volumes (including fellowship as primary procedurist)

Upper Endoscopy:                                                                         250

Colonoscopy:                                                                                   200

Endoscopic Retrograde Cholangiopancreatography (ERCP):        150

(including 80 sphincterotomies and 20 stent placements)

Endoscopic Ultrasound (EUS):                                                       150

Endoscopist annual volumes (including fellowship as primary procedurist)

Upper Endoscopy:             120

Colonoscopy:                    120

ERCP:                                  25

EUS                                      20

For endoscopists, procedures performed at any facility may be used toward volume. Endoscopists must have served as the primary procedurist for a procedure to qualify. If the endoscopist’s role as primary procedurist has been properly documented, procedures performed during fellowship may qualify. Cases in which the endoscopist served as co-endoscopist or assisting endoscopist do not qualify.

Each procedure used for volume must be thoroughly documented to enable a medical chart review.

Volume waivers may be approved in some circumstances.

Requirement 3: Physician Program Director

The applicant facility must appoint a Physician Program Director (or Co-Directors) for the Center of Excellence in Intervential Endoscopy program. The Physician Program Director(s) must:

  • Participate in the relevant decision-making meetings of the facility.
  • Be accredited, or in the process of becoming accredited as a Center of Excellence in Endoscopy.
  • Be primarily responsible for coordinating the multidisciplinary services and systems for endoscopy.
  • Participate in multidisciplinary team meetings.

Multidisciplinary team meetings should be held at least quarterly to ensure that decisions related to endoscopy are addressed in a comprehensive manner.

Requirement 4: Consultative Services

The applicant facility or associated inpatient facility must have an intensive care unit or written transfer agreement with an inpatient facility containing a critical care unit and a full complement of consultative services required for the routine and intensive care of endoscopy patients and their potential complications.

  • During the procedure and until discharge from the post-anesthesia care unit (PACU):
    • Anesthesiologist or certified registered nurse anesthetist (CRNA) who supervises anesthesia delivery on all endoscopy patients and is physically present until the patient is discharged from the endoscopy unit. Following endoscopy unit discharge, the anesthesiologist or CRNA must be available onsite within 30 minutes if needed.
  • Available on site 24/7 (or at all times when patients are present):
    • Physician certified in Advanced Cardiovascular Life Support (ACLS) or equivalent, or an acute response team, at least one of which is ACLS-certified, trained with an established protocol to follow in the event of a sudden respiratory or cardiac event.
  • Available on site within 30 minutes:
    • Critical care specialist – Physician with critical care credentials to manage complications, specifically a critical care physician/intensivist, hospitalist, cardiologist or pulmonologist
      • If a critical care specialist is not available, a written transfer protocol that details the transfer plan of endoscopy patients to other emergency or critical care facilities can be provided
    • Interventional radiologist
    • General surgeon
    • Intensivist

Requirement 5: Equipment and Instruments

The applicant facility must maintain a full line of equipment and surgical/endoscopic instruments to provide appropriate perioperative care for endoscopy patients. Facilities must have documented training for appropriate staff in the safe operation of this equipment.

If the facility does not have an emergency department or intensive care unit, it must have equipment, such as ventilators and hemodynamic monitoring equipment, necessary to resuscitate and stabilize critically ill patients until they can be transferred to another facility.

Requirement 6: Endoscopist Dedication and Qualified Call Coverage

Each applicant endoscopist spends a significant portion of his/her efforts in the field of gastroenterology/endoscopy and has active, full privileges in gastroenterology/endoscopy at the applicant facility.

Each applicant endoscopist is board-certified or an active candidate for board certification in their  specialty by the highest certifying authority available.

Each applicant endoscopist must complete at least 24 hours of continuing medical education (CME) focused on gastroenterology/endoscopy every three years. Only American Medical Association Physician’s Recognition Award Category 1 Credits or similar credits from a CME accrediting body outside the United States or three national or international meetings qualify.

The applicant facility has policies in place that require all endoscopists to have qualified call coverage, and each applicant endoscopist certifies that each covering endoscopist is capable of identifying and treating endoscopic complications.

Requirement 7: Clinical Pathways and Standardized Operating Procedures

The applicant formally develops and implements clinical pathways that facilitate the standardization of perioperative care for endoscopy procedures. The following pathways are required:

  1. Pre-operative patient evaluation/preparation, education, consent and plan of action for discharge that includes follow up.
  2. Anesthesia/sedation including airway management and pain control.
  3. Tracking of scopes from storage to use to reprocessing back to storage.
  4. Standardized documentation of procedure. Suggested items to include in procedure document:
    1. Date of procedure
    2. Patient identification
    3. Endoscopist
    4. Assistant
    5. Indications for procedure
    6. Documentation of informed consent
    7. Endoscopic procedure(s)
    8. Medications
    9. Anatomic extent of procedure/any limitations
    10. Findings
    11. Samples taken
    12. Therapies
    13. Complications
    14. Disposition (immediate aftercare (e.g. admission)
    15. Subsequent care
    16. Who gets copies of report.
  5. pylori monitoring and treatment

Requirement 8: Endoscopic Team and Support Staff

The applicant facility employs nurses and/or physician extenders who provide education and care to patients as well as procedure team trained to care for endoscopy patients. The applicant facility also appoints a program coordinator who supervises program development, patient and staff education, multidisciplinary team meetings and ongoing endoscopy program compliance.

The applicant facility provides ongoing, regularly scheduled staff education in-service education to ensure applicable staff have a basic understanding of endoscopy and the appropriate management of the endoscopy patient. In-service topics must include:

  • Signs and symptoms of common intraoperative/post procedure complications
  • Equipment and endoscopic instruments
  • Clinical pathways

Requirement 9: Patient Education

The facility and each applicant endoscopist must provide all endoscopy patients with comprehensive preoperative patient education.

The facility and each applicant endoscopist must also have a process for obtaining informed procedure consent and selecting procedures that are most appropriate for each patient’s condition.

Requirement 10: Continuous Quality Assessment

Each applicant endoscopist must collect prospective outcomes data on all patients who undergo endoscopy procedures in SRC’s Outcomes Database (or a similar qualifying database) in a manner consistent with applicable patient privacy and confidentiality regulations. This de-identified data must be available to SRC for initial and renewal inspections or upon request.

Program Fees

Initial Fees

Facility Application Fee: $3,975 USD
Surgeon Application Fee: $650 USD

  • Discounts may be available for surgeons that participate in multiple accreditation programs. Contact SRC for details.
  • Upon payment of application fees, applicants achieve Provisional Status and gain access to SRC’s Outcomes Database at no additional charge.

Site Inspection Fees

Domestic Site Inspection Fee (US, Canada, Mexico): $1,850 USD
International Site Inspection Fee: $5,450 USD

  • The site inspection fee covers a one-day inspection with one site inspector and includes one COE program with up to four co-applicant surgeons. A day will be added to the site inspection for every four additional co-applicant surgeons or each additional COE program. Each additional day is $925.
  • Applicant facilities are responsible for arranging and paying for the site inspector’s hotel, ground transportation and, if needed, an interpreter/translator. These items are not included in the standard site inspection fee.
  • Renewal inspections are required every three years to ensure ongoing program compliance.

Annual Fees

Facility Annual Fee: $3,975 USD
Surgeon Annual Fee: $650 USD

  • Annual participation fees will be billed one year after applicants achieve Provisional Status and each year thereafter.

Fees are subject to change without notice and are not refundable. Payment of required fees does not guarantee accreditation.