Opportunity Costs of Gastrointestinal Endoscopic Training in Canada

Depew, WT; Lc, Hookey; Vanner, SJ; Louw, J. A.; Lowe, CE; Ropeleski, MJ; Beyak, MJ; Lazarescu, Andra Luana; Wg, Paterson

doi:10.1155/2010/304689

Cited by 12 publications

(6 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study showed that trainees used more sedation, had longer procedures, and resulted in more patient discomfort compared to staff alone. Our group has previously reported extension of procedure time by 50 % in ambulatory colonoscopy when trainees are involved 36 .…”

Section: Discussionmentioning

confidence: 91%

Patient comfort scores do not affect endoscopist behavior during colonoscopy, while trainee involvement has negative effects on patient comfort

et al. 2017

View full text Add to dashboard Cite

Introduction Patient comfort is an important part of endoscopy and reflects procedure quality and endoscopist technique. Using the validated, Nurse Assisted Patient Comfort Score (NAPCOMS), this study aimed to determine whether the introduction of NAPCOMS would affect sedation use by endoscopists. Patients and methods The study was conducted over 3 phases. Phase One and Two consisted of 8 weeks of endoscopist blinded and aware data collection, respectively. Data in Phase Three was collected over a 5-month period and scores fed back to individual endoscopists on a monthly basis. Results NAPCOMS consists of 3 domains – pain, sedation, and global tolerability. Comparison of Phase One and Two, showed no significant differences in sedative use or NAPCOMS. Phase Three data showed a decline in fentanyl use between individual months ( P = 0.035), but no change in overall NAPCOMS. Procedures involving trainees were found to use more midazolam ( P = 0.01) and fentanyl ( P = 0.01), have worse NAPCOMS scores, and resulted in longer procedure duration ( P < 0.001). Data comparing gastroenterologists and general surgeons showed increased fentanyl use ( P = 0.037), decreased midazolam use ( P = 0.001), and more position changes ( P = 0.002) among gastroenterologists. Conclusions The introduction of a patient comfort scoring system resulted in a decrease in fentanyl use, although with minimal clinical significance. Additional studies are required to determine the role of patient comfort scores in quality control in endoscopy. Procedures completed with trainees used more sedation, were longer, and had worse NAPCOMS scores, the implications of which, for teaching hospitals and training programs, will need to be further considered.

show abstract

Section: Discussionmentioning

confidence: 91%

Patient comfort scores do not affect endoscopist behavior during colonoscopy, while trainee involvement has negative effects on patient comfort

et al. 2017

View full text Add to dashboard Cite

show abstract

“…There are many plausible explanations for this. Colonoscopies involving trainees can be up to 50% longer in duration, again possibly necessitating higher doses of medication based on total procedure time alone 18 . In addition, by virtue of their novice status, trainees likely lack the technical expertise to navigate turns in a comfortable manner, identify and reduce loops in the colon, and effectively and reliably perform other manoeuvres that minimize patient discomfort during colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Failed Conscious Sedation in Patients Undergoing an Outpatient Colonoscopy and Implications for the Adenoma Detection Rate

Cassell

Ross

Chang

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Guidelines to triage patients to conscious sedation (cS) or monitored anaesthesia care (MAc) for colonoscopy do not exist. We aimed to identify the cS failure rate, predictors of failure, and its impact on the adenoma detection rate (ADR). Strict (based on patient experience) and expanded (based on doses of sedative medications) definitions of CS failure were used. Patient and procedure-related variables were extracted. Multivariable logistic regression identified predictors for CS failure and the ADR. Among 766 patients, 29 (3.8%) and 175 (22.8%) patients failed CS by strict and expanded definitions, respectively. Female gender (OR 3.50; 95% CI: 1.37-8.94) and fellow involvement (OR 4.15; 95% CI: 1.79-9.58) were associated with failed CS by the strict definition. Younger age (OR 1.27, 95% CI: 1.07-1.49), outpatient opiate use (OR 1.71; 95% CI 1.03-2.84), use of an adjunct medication (OR 3.34; 95% CI: 1.94-5.73), and fellow involvement (OR 2.20; 95% CI: 1.31-3.71) were associated with failed CS by the expanded definition. Patients meeting strict failure criteria had a lower ADR (OR 0.30; 95% CI: 0.12-0.77). Several clinical factors may be useful for triaging to MAC. The ADR is lower in patients meeting strict criteria for failed cS.

show abstract

“…This enabled provision of baseline performance metrics and identification of process inefficiencies from multiple perspectives. Some of the limitations of the present study are that it was based at a single ambulatory endoscopy centre and did not directly address some other factors recognized to impact efficiency such as inpatient endoscopic procedures, impact of trainee involvement, or the range of endoscopist proficiencies on the efficiency of the endoscopy unit [ 5 , 18 ]. Last-minute patient cancellations likely impact efficiency, and prearrival factors are being investigated as a separate study.…”

Section: Discussionmentioning

confidence: 99%

A Patient Flow Analysis: Identification of Process Inefficiencies and Workflow Metrics at an Ambulatory Endoscopy Unit

Almeida

Paterson

Craig

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

View full text Add to dashboard Cite

Background. The increasing demand for endoscopic procedures coincides with the paradigm shift in health care delivery that emphasizes efficient use of existing resources. However, there is limited literature on the range of endoscopy unit efficiencies. Methods. A time and motion analysis of patient flow through the Hotel-Dieu Hospital (Kingston, Ontario) endoscopy unit was followed by qualitative interviews. Procedures were directly observed in three segments: individual endoscopy room use, preprocedure/recovery room, and overall endoscopy unit utilization. Results. Data were collected for 137 procedures in the endoscopy room, 139 procedures in the preprocedure room, and 143 procedures for overall room utilization. The mean duration spent in the endoscopy room was 31.47 min for an esophagogastroduodenoscopy, 52.93 min for a colonoscopy, 30.47 min for a flexible sigmoidoscopy, and 66.88 min for a double procedure. The procedure itself accounted for 8.11 min, 34.24 min, 9.02 min, and 39.13 min for the above procedures, respectively. The focused interviews identified the scheduling template as a major area of operational inefficiency. Conclusions. Despite reasonable procedure times for all except colonoscopies, the endoscopy room durations exceed the allocated times, reflecting the impact of non-procedure-related factors and the need for a revised scheduling template. Endoscopy units have unique operational characteristics and identification of process inefficiencies can lead to targeted quality improvement initiatives.

show abstract

Opportunity Costs of Gastrointestinal Endoscopic Training in Canada

Abstract: Resident training in colonoscopy in a Canadian certified training program has significant negative effects on case throughput and endoscopist billings. These factors should be considered in any assessment of performance in similar training environments.

Cited by 12 publications

References 9 publications

Patient comfort scores do not affect endoscopist behavior during colonoscopy, while trainee involvement has negative effects on patient comfort

Patient comfort scores do not affect endoscopist behavior during colonoscopy, while trainee involvement has negative effects on patient comfort

Predictors of Failed Conscious Sedation in Patients Undergoing an Outpatient Colonoscopy and Implications for the Adenoma Detection Rate

A Patient Flow Analysis: Identification of Process Inefficiencies and Workflow Metrics at an Ambulatory Endoscopy Unit

Contact Info

Product

Resources

About