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Canadian Journal of Gastroenterology
Volume 27, Issue 2, Pages 74-82
Original Article

The Endoscopy Global Rating Scale – Canada: Development And Implementation of a Quality Improvement Tool

Donald MacIntosh,1 Catherine Dubé,2 Roger Hollingworth,3 Sander Veldhuyzen van Zanten,4 Sandra Daniels,5 and George Ghattas6

1Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia, Canada
2Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
3Division of Gastroenterology, The Credit Valley Hospital, Mississauga, Ontario, Canada
4Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
5Canadian Association of Gastroenterology, Oakville, Ontario, Canada
6Division of Gastroenterology, McGill University, Montreal, Quebec, Canada

Received 24 October 2012; Accepted 10 November 2012

Copyright © 2013 Canadian Association of Gastroenterology. This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (, which permits reuse, distribution, and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes.


BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality highlight the need for endoscopy facilities to review the quality of the service they offer.

OBJECTIVE: To adapt the United Kingdom Global Rating Scale (UK-GRS) to develop a web-based and patient-centred tool to assess and improve the quality of endoscopy services provided.

METHODS: Based on feedback from 22 sites across Canada that completed the UK endoscopy GRS, and integrating results of the Canadian consensus on safety and quality indicators in endoscopy and other Canadian consensus reports, a working group of endoscopists experienced with the GRS developed the GRS-Canada (GRS-C).

RESULTS: The GRS-C mirrors the two dimensions (clinical quality and quality of the patient experience) and 12 patient-centred items of the UK-GRS, but was modified to apply to Canadian health care infrastructure, language and current practice. Each item is assessed by a yes/no response to eight to 12 statements that are divided into levels graded D (basic) through A (advanced). A core team consisting of a booking clerk, charge nurse and the physician responsible for the unit is recommended to complete the GRS-C twice yearly.

CONCLUSION: The GRS-C is intended to improve endoscopic services in Canada by providing endoscopy units with a straightforward process to review the quality of the service they provide.