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.