Abstract
Background
Limited data exists on the quality of advanced endoscopic procedures completed by trainees.
Aims
The aim of this study was to describe the quality of endoscopic ultrasound (EUS) procedures performed by advanced endoscopy trainees with staff supervision (TS), using diagnostic yield (DY) and adverse event risk (AE) as quality indicators.
Methods
We performed a retrospective chart review of patients who underwent EUS at The Ottawa Hospital between September 2009 and May 2015. Data was collected regarding patient demographics, procedure details, and DYs. AEs were identified by reviewing all emergency room visits and hospitalizations within 30 days of the patient’s EUS procedure. Relation of the hospital encounter (definitely, possibly and not) to the EUS procedure was established by consensus using pre-defined criteria.
Results
1647 EUS cases were analyzed. The median patient age was 64 (IQR, 53–73) years and 50% of the patients were male. The EUS DY was 78% and the risk of an AE was 3.5% (58 cases). 27% (450) of all EUS procedures were performed by TS. Overall, TS procedures were not associated with a reduction in DY (80%, p = 0.2) or excess AE risk (4.9%, p = 0.06) in comparison to procedures performed by a staff alone (SA). However, TS DY improved every 4 months (Table 1; 76%, 79%, 84%) and TS AE risk was highest in the first and last 4 months of training (Table 1; 6.8%, 2.1%, 5.9%). This trend was not seen for procedures performed by SA (see Table 1).
Conclusions
In the first four months of training, EUS procedures performed by trainees may be associated with lower DY and increased risk of AEs. This warrants further evaluation to determine how to avoid compromising service quality during advanced endoscopy training.
Table 1. Adverse event risk and diagnostic yield during the training period.
| Training Period | Adverse Event Risk (n = 1647) | Diagnostic Yield (n = 878) | ||||
|---|---|---|---|---|---|---|
| SA (%; n = 1197) | TS (%; n = 450) | P-value* | SA (n = 614) | TS (n = 264) | P-value* | |
| 1 | 13 (2.9) | 8 (6.8) | 0.06 | 76% | 76% | 0.86 |
| 2 | 9 (2.6) | 3 (2.1) | 1.00 | 79% | 79% | 0.93 |
| 3 | 14 (3.5) | 11 (5.9) | 0.17 | 74% | 84% | 0.04 |
*Chi-square or Fisher exact test as required comparing the SA and TS groups. SA= staff alone; TS = trainee with staff
Funding Agencies
None