write some suggestions of ideas for a QI project/Audit in the Gastroenterology department as a final year medical student in Bulgaria (Europe). It should be of good impact overall
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quality improvement audit gastroenterology medical student project ideas 2024 2025
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gastroenterology QI audit topics Bulgaria Eastern Europe endoscopy IBD liver
Here are well-thought-out QI/Audit project ideas tailored to your context as a final-year student in a Bulgarian gastroenterology department. Each one is practical, impactful, and achievable within your constraints.
QI / Audit Project Ideas - Gastroenterology (Bulgaria)
1. Audit of Bowel Preparation Quality Before Colonoscopy
Why it matters: Inadequate bowel prep is one of the most common, measurable, and correctable causes of missed lesions and repeat procedures. It directly impacts adenoma detection rates (ADR) - a core quality metric in endoscopy.
What you would do:
- Retrospectively review colonoscopy reports over a defined period and extract Boston Bowel Preparation Scale (BBPS) scores
- Identify what proportion of procedures had inadequate prep (score < 6 total or any segment < 2)
- Correlate with prep protocol used, patient education given, and procedure timing (AM vs. PM)
- Compare against ESGE quality standard: adequate prep in ≥ 90% of procedures
Output: A report with a proposed standardized patient instruction sheet in Bulgarian, and/or a recommendation to switch to same-day split-dose prep for afternoon lists.
Feasibility: High - data already in endoscopy reports. No patient contact required.
2. Audit of Adenoma Detection Rate (ADR) Against ESGE Benchmarks
Why it matters: ADR is the single best predictor of interval colorectal cancer. ESGE mandates ≥ 25% ADR for screening colonoscopies. Many units in Eastern Europe have not formally audited this.
What you would do:
- Collect data from colonoscopy reports and histology results for a 6-12 month period
- Calculate ADR per endoscopist and overall
- Audit withdrawal time documentation (ESGE standard: ≥ 6 minutes average)
- Identify whether caecal intubation rate is documented (standard: ≥ 90%)
Output: A dashboard/table of performance by endoscopist compared to ESGE benchmarks. This is publishable as a service evaluation.
Feasibility: High - uses existing records. Aligns directly with ESGE quality guidelines.
3. Audit of H. pylori Test-and-Treat Adherence in Dyspepsia
Why it matters: H. pylori prevalence in Bulgaria is among the highest in Europe (estimated 60-70%). Maastricht VI / Florence Consensus (2022) gives clear guidance on who should be tested and treated. Non-adherence is common in routine practice.
What you would do:
- Audit outpatient referrals or admissions with dyspepsia/peptic ulcer disease
- Check: Was H. pylori testing done? Was eradication therapy prescribed for positives? Was test-of-cure (UBT or stool antigen at 4-6 weeks post-treatment) performed?
- Compare rates against Maastricht VI recommendations
Output: Gap analysis and a proposed local protocol or checklist for H. pylori management. Particularly relevant given Bulgaria's high prevalence.
Feasibility: Very high - outpatient notes/discharge letters are sufficient. Very targeted question.
4. Audit of Cirrhosis Surveillance (HCC and Varices) Compliance
Why it matters: Bulgaria has high rates of HCV- and alcohol-related cirrhosis. EASL guidelines recommend 6-monthly liver ultrasound + AFP for HCC surveillance, and variceal screening by endoscopy. Surveillance gaps are a known problem across Eastern Europe.
What you would do:
- Identify patients with a confirmed diagnosis of cirrhosis over a 12-month period
- Audit whether each patient had: 6-monthly USS/AFP, OGD for varices at diagnosis, repeat OGD per Baveno VII criteria, MELD score documented, nutritional status assessed
- Calculate the proportion meeting each surveillance standard
Output: A clear audit showing compliance rates for each metric, with a proposed patient tracking/recall system for the department.
Feasibility: Moderate - requires access to patient records. Could be done retrospectively. Very impactful.
5. Audit of IBD Biologic Therapy Monitoring
Why it matters: Patients on anti-TNF therapy (infliximab, adalimumab) need regular monitoring - TB screening before starting, LFTs, FBC, lipid profiles, and TB/hepatitis B status. Gaps in monitoring increase risk of serious adverse events.
What you would do:
- Identify IBD patients on biologics in the department
- Audit pre-biologic screening documentation (TB test, hepatitis B serology, varicella status)
- Audit ongoing monitoring: interval blood tests, drug level/anti-drug antibody measurement if available
- Compare against ECCO (European Crohn's and Colitis Organisation) guidelines
Output: A monitoring checklist/template and gap analysis report.
Feasibility: Moderate - IBD patients are often well-documented in registers. Highly relevant to European practice.
6. Re-audit / Audit of Upper GI Endoscopy Report Completeness
Why it matters: OGD reports should contain minimum mandatory data per ESGE - indication, landmarks (Z-line level, GOJ), findings, histology taken, and management plan. Incomplete reports delay follow-up and are a patient safety issue.
What you would do:
- Review a consecutive series of OGD reports (e.g. 50-100 from a 3-month period)
- Check each report against a defined minimum dataset based on ESGE/BSG standards
- Identify the most common omissions
- Propose a structured report template
Output: A completion rate per data field, and a draft structured OGD template for the department.
Feasibility: Very high - requires only report access. Quick to do.
7. Audit of Barrett's Oesophagus Surveillance Intervals
Why it matters: Barrett's oesophagus is a precursor to oesophageal adenocarcinoma. ESGE recommends surveillance intervals based on segment length and dysplasia grade. Under- or over-surveillance is common.
What you would do:
- Identify all patients with a documented diagnosis of Barrett's in the endoscopy database
- Check: Was Prague classification (C&M criteria) used and documented? Was the correct surveillance interval planned? Was the next scope performed within the recommended window?
- Compare against ESGE 2023 Barrett's guidelines
Output: Compliance rates and a proposed Barrett's surveillance register/recall list.
Choosing Your Project - Quick Guide
| Project | Data Access | Time Required | Publishability | Impact |
|---|---|---|---|---|
| Bowel prep audit | Easy | 2-3 weeks | Good | High (safety) |
| ADR audit | Easy | 2-4 weeks | Excellent | High (cancer) |
| H. pylori adherence | Easy | 2-3 weeks | Good | High (prevalence) |
| Cirrhosis surveillance | Moderate | 3-5 weeks | Excellent | Very high |
| IBD biologics monitoring | Moderate | 3-4 weeks | Good | High |
| OGD report completeness | Very easy | 1-2 weeks | Moderate | Moderate |
| Barrett's surveillance | Moderate | 3-4 weeks | Good | High |
Practical Tips for Bulgaria Specifically
- H. pylori and cirrhosis projects are especially high-yield given local disease burden (high H. pylori prevalence, significant alcohol-related liver disease)
- Frame your project against ESGE or EASL/ECCO guidelines rather than UK/US ones - these are the most directly applicable European standards
- Even a small retrospective audit of 50-100 patients is sufficient at this stage
- Discuss with your supervising consultant - departments with an existing endoscopy logbook will make the ADR/bowel prep audits very quick to complete
- A simple before/after intervention design (e.g. introducing a patient instruction leaflet) significantly increases the impact and chance of publication
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