The
Global Rating Scale (GRS) was created in 2004 as a quality improvement
and assessment tool for the gastrointestinal endoscopy service.
Gastrointestinal endoscopy is the direct visualisation of the
gastrointestinal tract. Gastrointestinal endoscopy is used for
diagnosis and treatment of gastroenterology disorders. It plays a major
role detecting and treating gastrointestinal cancers and pre-cancers,
particularly bowel cancer. The GRS assesses 12 key aspects of the experience of patients
having an endoscopy. Each aspect (or item) is scored on a scale of D to
A where D is a basic level and A is a very high level of achievement.
The twelfth item: ‘ability to provide feedback to the service’ ensures
that nothing important is missed by the scale and that a service
constantly monitors (and responds to) patient feedback. For a more
detailed explanation of the GRS and how it works please click on ‘what is the GRS?’
Each endoscopy unit in England is required to complete the scale
every 6 months. The GRS is a self report tool; however, the majority of
hospital based endoscopy units have been visited by teams with
extensive knowledge of the GRS and the self scoring is found to be
mostly very accurate. Endoscopy teams are as likely to underestimate
their achievements as to overestimate them.
There have now been six National censuses since April 2005 (click
here for the results). These show very high levels of engagement with
the GRS and steadily improving scores. The exception to this is the
appropriateness item where scores took a dip in the last census. This
occurred following a change in content of the item intended to better
reflect the current approach for determining whether an endoscopy is
appropriate or not.
The Endoscopy GRS has been adopted in Scotland, Wales and Northern
Ireland. It is being tested in Canada. A new GRS has been created for
the Audiology service which is currently being tested.