Presenter Status

Student

Abstract Type

QI

Primary Mentor

Dr. Thomas Attard

Start Date

5-5-2022 11:30 AM

End Date

5-5-2022 1:30 PM

Presentation Type

Poster Presentation

Description

Problem Statement/Question: Advanced therapeutic endoscopy is infrequently needed but critical in the management of children with complex gastroenterology disorders. Hands-on experience in specific advanced techniques, set up of endoscopy equipment and familiarity with new ancillary equipment for use during endoscopy have been intra-departmentally identified as potential areas for improvement.

Background/Project Intent: Our aim is to improve provider scoring on an endoscopy practice test based on technical aspects of therapeutic techniques, indications and set up of standard and new endoscopic equipment by 20% over pre-practice session testing.

Methods: The Model for Improvement framework was utilized. A multidisciplinary team was created including GI leadership, GI nursing, GI tech and advanced endoscopy providers. Endoscopic hemostatic techniques, polypectomy and esophageal dilation were identified as frequent areas of difficulty for endoscopists. Accreditation and Regulatory Readiness, Infection Control, and Advanced Practice Programs were engaged to comply with institutional safety and standards requirements. Root causes were identified and guided implementation of intervention. A multi-station (6) hybrid model of hands-on demonstrations and (3) practical sessions using a pigstomach model for endoscopy was adopted. Dedicated, animal endoscopy-only therapeutic endoscopes (3; EG-29i10) were loaned from Pentax Medical®. Porcine esophagus and stomach were responsibly sourced from a local, state licensed abattoir (Bichelmeyer Meats, Kansas City, KS) and were used for simulation. Disposable supplies were also used for both simulation and hands-on demonstration. Proficient endoscopists – demonstrators provided structured pre- and post-test questions focused on practical aspects of their respective stations. All endoscopists and trainees were invited to the educational-practice session. A 4-hour block was reserved on an afternoon normally reserved for administrative duties. Our outcomes measure was % improvement in competence test scores; our goal was an improvement of 20%. Our process measure was number of providers and trainees attending the activity expressed as a percentage of the total; our goal was > 50%. Our balancing measure was the amount of time committed to the training session by the attendees; our goal was < 2 hours. Attendees rating of the utility of the activity was captured on 5 point Likert scale. Our planned next PDSA cycle will address knowledge gap specific to more senior providers.

Results: Overall, 14 providers (63.6% of total; 70% if adjusted for individuals on medical leave) were able to complete the endoscopy practice tests (5 fellows; 4 attendings with 6-10 years of experience, and 5 attendings with > 11 years of experience). Our outcome measure: improvement in competence test scores, increased from an average pre-test score of 51.3% to an average post-test score of 76.6% and therefore exceeded our goal. Our outcome measure is reported in Fig. 1. Our process measure exceeded our goal: 63.6% of providers and trainees attended the activity. Our balancing measure was at goal with all respondents reporting 2 hours committed to the activity. Relatedly, 100% of participants rated the activity as “Very Useful” on the Likert Scale.

Conclusions: Provider scoring on an endoscopy practice test improved significant by 25.3% over baseline. Benefit was greater for trainees and more junior providers. Future sessions will increase focus on educational needs of senior providers.

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May 5th, 11:30 AM May 5th, 1:30 PM

Improving Advanced Therapeutic Endoscopy Performance at an Academic Children's Hospital

Problem Statement/Question: Advanced therapeutic endoscopy is infrequently needed but critical in the management of children with complex gastroenterology disorders. Hands-on experience in specific advanced techniques, set up of endoscopy equipment and familiarity with new ancillary equipment for use during endoscopy have been intra-departmentally identified as potential areas for improvement.

Background/Project Intent: Our aim is to improve provider scoring on an endoscopy practice test based on technical aspects of therapeutic techniques, indications and set up of standard and new endoscopic equipment by 20% over pre-practice session testing.

Methods: The Model for Improvement framework was utilized. A multidisciplinary team was created including GI leadership, GI nursing, GI tech and advanced endoscopy providers. Endoscopic hemostatic techniques, polypectomy and esophageal dilation were identified as frequent areas of difficulty for endoscopists. Accreditation and Regulatory Readiness, Infection Control, and Advanced Practice Programs were engaged to comply with institutional safety and standards requirements. Root causes were identified and guided implementation of intervention. A multi-station (6) hybrid model of hands-on demonstrations and (3) practical sessions using a pigstomach model for endoscopy was adopted. Dedicated, animal endoscopy-only therapeutic endoscopes (3; EG-29i10) were loaned from Pentax Medical®. Porcine esophagus and stomach were responsibly sourced from a local, state licensed abattoir (Bichelmeyer Meats, Kansas City, KS) and were used for simulation. Disposable supplies were also used for both simulation and hands-on demonstration. Proficient endoscopists – demonstrators provided structured pre- and post-test questions focused on practical aspects of their respective stations. All endoscopists and trainees were invited to the educational-practice session. A 4-hour block was reserved on an afternoon normally reserved for administrative duties. Our outcomes measure was % improvement in competence test scores; our goal was an improvement of 20%. Our process measure was number of providers and trainees attending the activity expressed as a percentage of the total; our goal was > 50%. Our balancing measure was the amount of time committed to the training session by the attendees; our goal was < 2 hours. Attendees rating of the utility of the activity was captured on 5 point Likert scale. Our planned next PDSA cycle will address knowledge gap specific to more senior providers.

Results: Overall, 14 providers (63.6% of total; 70% if adjusted for individuals on medical leave) were able to complete the endoscopy practice tests (5 fellows; 4 attendings with 6-10 years of experience, and 5 attendings with > 11 years of experience). Our outcome measure: improvement in competence test scores, increased from an average pre-test score of 51.3% to an average post-test score of 76.6% and therefore exceeded our goal. Our outcome measure is reported in Fig. 1. Our process measure exceeded our goal: 63.6% of providers and trainees attended the activity. Our balancing measure was at goal with all respondents reporting 2 hours committed to the activity. Relatedly, 100% of participants rated the activity as “Very Useful” on the Likert Scale.

Conclusions: Provider scoring on an endoscopy practice test improved significant by 25.3% over baseline. Benefit was greater for trainees and more junior providers. Future sessions will increase focus on educational needs of senior providers.

 

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