Improving colonoscopy quality through individualised training programmes.

INTRODUCTION: In Denmark, quality-improvement initiatives aimed at providing a better colonoscopy service are few. The primary objective of this study was to improve colonoscopy quality at Aalborg University Hospital, Denmark, using structured training programmes. The secondary aim was to introduce a system for individual colonoscopist performance monitoring. METHODS: We conducted a colonoscopy-quality pilot study covering two major quality performance indicators: caecum intubation rate (CIR) and polyp detection rate (PDR). The pilot study was followed by colonoscopy training programmes offering experienced colonoscopists colonoscopy skills upgrading, polypectomy and train-the-trainers courses taught by English experts. Junior doctors completed a 20-day module-based colonoscopy-training programme. A regional individual colonoscopy quality-reporting system was developed as a supplementary file within the electronic health records. RESULTS: The CIR increased from 87.1% to 92.1% (p less-than 0.001) and the PDR from 33.7% to 41.7% (p less-than 0.001) in the course of the structured training programme. Multivariable analysis adjusting for patient sex, patient age and colonoscopy indication showed a significant increase in CIR (p less-than 0.001), but not in PDR (p = 0.19). The colonoscopy quality reporting system was introduced and now provides biannual feedback to all colonoscopists. CONCLUSIONS: Quality-improvement initiatives may lead to an improved CIR and possibly PDR. Nationwide training programmes and performance monitoring should be implemented to further improve and monitor colonoscopy quality. FUNDING: none. TRIAL REGISTRATION: not relevant.

Colonoscopy adverse events: are we getting the full picture?

INTRODUCTION: Colonoscopy adverse events (AEs) are commonly underreported and standardised reporting is rarely used. We aimed to investigate AEs associated with colonoscopy in a real world setting, using the American Society of Gastrointestinal Endoscopy (ASGE) lexicon. METHODS: This retrospective cohort study of AEs related to outpatient colonoscopies performed in the North Denmark Region from 2015 to 2018 identified AEs from readmission within eight days or death within 30 days of colonoscopy. AEs were investigated in electronic health records and categorised, attributed and graded according to the ASGE lexicon. RESULTS: Of 49,445 colonoscopies performed, 1141 were potentially associated with AEs (23.07‰). Electronic health record review left 489 AEs attributed to colonoscopy (9.9‰); categorised as cardiovascular (0.65‰), pulmonary (0.36‰), thromboembolic (0.10‰), instrumental incl. perforations (0.99‰), bleeding (3.07‰), infection (0.87‰), drug reactions (0.04‰), pain (2.00‰), integument (damage to skin/bones) (0.34‰) and other (1.62‰) AEs. Ten (0.20‰) AEs were fatal, but only one was procedure related (perforation). All shearing force perforations occurred in the sigmoid colon. Most polypectomy perforations occurred in the caecum (60%). CONCLUSIONS: Colonoscopy carries important procedure and non-procedure related risks. Non-procedure related AEs are likely underreported. Better attention to patients with pre-existing diseases and further colonoscopist training may lower AE rates. A standardised colonoscopy AE reporting system is warranted.

[One third of Danish doctors specializing in diagnostic radiology do not feel sufficiently equipped in terms of medical expertise]. / Hver tredje hoveduddannelseslæge i diagnostisk radiologi føler sig ikke rustet til rollen som medicinsk ekspert.

An internet-based survey among Danish doctors specializing in diagnostic radiology revealed differences with respect to the length of internships at regional and university hospitals as well as the educational environment. The university hospitals were generally evaluated to have the best educational facilities except within practical skills. Therefore, it seems necessary to optimize the educational environment at regional hospitals, especially within medical expertise and scientific skills which are key elements regarding continuous development and quality assurance within radiology.

Is current surgical training efficient? A national survey.

OBJECTIVES: Evaluation of surgical training in Denmark is competency based with no requirement for a specific number of procedures. This may affect monitoring of surgical progress adversely and cause an underestimation of the time needed to acquire surgical competencies. We investigated the number of common surgical procedures performed by trainees. Trainees' and consultants' expectations from the training program were also investigated. DESIGN AND PARTICIPANTS: A questionnaire was sent to all 115 surgical trainees in Denmark. We asked how many common surgical procedures the trainees had performed during their postgraduate training, whether self-reported procedural confidence was achieved during their training, and whether their training expectations were met. Another questionnaire dealt with the consultants' expectations of the surgical training. RESULTS: The total number of common surgical procedures (Lichtenstein hernia repair, appendectomy, laparoscopic appendectomy, and laparoscopic cholecystectomy) that were performed varied between trainees. One group performed few common procedures during training. A low number in 1 procedure correlated with a similar pattern in other procedures. Approximately one-third did not perform common elective procedures independently until their fifth year. Consultants and trainees viewed training differently. CONCLUSIONS: Our study reveals no common trend in the numbers and types of procedures performed during training. The number of procedures seems to reflect the individual trainee and a local tradition rather than the particular training program. An informal competency-based assessment system with lack of quantitative requirements evidently involves a risk of skewness in training.

[Initial experiences with laparoscopic incisional hernial repair]. / Initielle erfaringer med laparoskopisk operationfor hernia incisionalis.

INTRODUCTION: Incisional hernia following laparotomy remains an important problem. Laparoscopic repair has become the method of choice in recent years. The present article presents the outcome of laparoscopic incisional hernia mesh repair at Viborg Hospital in the years 2003-2006. MATERIAL AND METHODS: We retrospectively identified 114 patients who had undergone laparoscopic hernia repair during the relevant period. The patients received a questionnaire regarding satisfaction, pain and recurrence. Patients reporting any inconvenience were offered a consultation. RESULTS: Among the 114 included patients, ten procedures were converted to open laparotomy, six of which were converted due to recognized bowel injury. One case of bowel injury was managed laparoscopically. One case of bowel injury was recognized during reoperation the following day. Another four patients experienced reoperations for other reasons, mainly bleeding. The mean hospital stay was one day. A total of 12 patients had a recurrent hernia. The mean follow-up was 14 months. CONCLUSION: We conclude that laparoscopic incisional hernia repair is a useful surgical procedure with short hospital stay and high patient satisfaction. There is, however, a certain risk of bowel injury associated with this procedure.

[Multiple bowel perforations after swallowing magnetic toys]. / Multiple tarmperforationer efter indtagelse af magnetisk legetøj.

Ingestion of small foreign bodies is common in children, and usually does not cause any harm to the gastrointestinal tract. But ingestion of multiple magnets can be hazardous because of the strong attraction of the magnets through the bowel wall, which may lead to bowel wall necrosis and perforation. We describe the case of a 6-year-old autistic boy who swallowed 4 magnets which led to bowel obstruction and 8 small perforations. It is important to be aware of this potential risk if children ingest small magnetic toys.