Duration of colonoscopy: The effect of trainee presence on procedure time
Recent new Medicare regulations for teaching physicians have focused attention on the additional costs associated with training. For endoscopists, a major component of this teaching effort is the extended procedure time associated with supervision of trainees. To determine the magnitude of this factor, we examined procedure times at 5 teaching hospitals. Methods: Participating centers use a common computerized endoscopy database (GITrac 2.0, ASD MediTrac) for procedure reporting. Physician-entered data include endoscopy start and end time; the program calculates procedure duration. Other data entered include pre-endoscopy risk factors, ASA score, attending and trainee endoscopists names, findings, and therapeutic treatments. All consecutive procedures at each center were entered in the database. Patient demographics were purged from the pooled database, which was then analyzed using SAS software. Results: 7689 colonoscopies were analyzed. The mean procedure time for all procedures was 37.0 minutes. For procedures with and without a trainee, the mean times were, respectively, 38.5 min and 34.6 min.; this difference was statistically significant (p = 0.0001). This prolongation was observed to a similar degree at all centers. To determine if this effect was due to assignment of specific types of procedures to trainees, we examined the procedure times for several factors as shown: Factor time with trainee time without trainee p value ASA=1 (healthy) 39.3 min 34.9 min 0.0001 ASA>1 38.2 min 34.1 min 0.0001 inpatient status 38.3 min 32.8 min 0.0001 no risk factors 38.4 min 34.4 min 0.0001 1 or more risks 39.3 min 35.7 min 0.0096 no therapy 33.8 min 31.8 min 0.0001 therapeutic case 43.9 min 41.2 min 0.0032 Conclusion: Colonoscopy involving endoscopy trainees results in prolongation of the procedure time by approximately 11%. Similar degrees of prolongation were seen among several types of procedures. This information may be useful in assessing the effect of endoscopy trainee presence on procedural costs or reimbursement.
Nickl, N; Vaughan, J; Cotton, PB; Jowell, P; Libby, E; Schutz, S
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