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Gangu K, Basida S, Awan RU, Butt MA, Reed A, Afzal R, Shekhar R, Chela HK, Daglilar ES, Sheikh AB. July effect in clinical outcomes of esophagogastroduodenoscopy performed at teaching hospitals in the United States. Proc AMIA Symp 2023; 36:478-482. [PMID: 37334097 PMCID: PMC10269412 DOI: 10.1080/08998280.2023.2204804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/12/2023] [Indexed: 06/20/2023] Open
Abstract
Background Esophagogastroduodenoscopy (EGD) is a common procedure used for both diagnosis and treatment, but carries risks such as bleeding and perforation. The "July effect"-described as increased complication rates during the transition of new trainees-has been studied in other procedures, but has not been thoroughly evaluated for EGD. Methods We used the National Inpatient Sample database for 2016 to 2018 to compare outcomes in EGD performed between July to September and April to June. Results Approximately 0.91 million patients in the study received EGD between July to September (49.35%) and April to June (50.65%), with no significant differences between the two groups in terms of age, gender, race, income, or insurance status. Of the 911,235 patients, 19,280 died during the study period following EGD, 2.14% (July-September) vs 1.95% (April-June), with an adjusted odds ratio of 1.09 (P < 0.01). The adjusted total hospitalization charge was $2052 higher in July-September ($81,597) vs April to June ($79,023) (P < 0.005). The mean length of stay was 6.8 days (July-September) vs 6.6 days (April-June) (P < 0.001). Conclusions The results of this study are reassuring as the July effect on inpatient outcomes for EGDs was not significantly different according to our study. We recommend seeking prompt treatment and improving new trainee training and interspecialty communication for better patient outcomes.
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Affiliation(s)
- Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Sanket Basida
- Department of Internal Medicine, University of Missouri System, Columbia, Missouri
| | - Rehmat Ullah Awan
- Department of Internal Medicine, Ochsner Rush Medical Center, Meridian, Mississippi
| | - Mohammad Ali Butt
- Department of Internal Medicine, Allegheny General Hospital – Western Pennsylvania Hospital Medical Education Consortium, Pittsburgh, Pennsylvania
| | - Austin Reed
- Department of Internal Medicine, University of Missouri System, Columbia, Missouri
| | - Rao Afzal
- Department of Internal Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Harleen Kaur Chela
- Department of Internal Medicine, West Virginia University Health Sciences Center Charleston Division, Charleston, West Virginia
| | - Ebubekir S. Daglilar
- Department of Internal Medicine, West Virginia University Health Sciences Center Charleston Division, Charleston, West Virginia
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Shahin Z, Shah GH, Apenteng BA, Waterfield K, Samawi H. A Nationwide Study of the “July Effect” Concerning Postpartum Hemorrhage and Its Risk Factors at Teaching Hospitals across the United States. Healthcare (Basel) 2023; 11:healthcare11060788. [PMID: 36981445 PMCID: PMC10048184 DOI: 10.3390/healthcare11060788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023] Open
Abstract
Objective To assess the “July effect” and the risk of postpartum hemorrhage (PPH) and its risk factors across the U.S. teaching hospitals. Method This study used the 2018 Nationwide Inpatient Sample (NIS) and included 2,056,359 of 2,879,924 single live-birth hospitalizations with low-risk pregnancies across the U.S. teaching hospitals. The International Classification of Diseases, Tenth Revision (ICD-10) from the American Academy of Professional Coders (AAPC) medical coding was used to identify PPH and other study variables. Multivariable logistic regression models were used to compare the adjusted odds of PPH risk in the first and second quarters of the academic year vs. the second half of the academic year. Results Postpartum hemorrhage occurred in approximately 4.19% of the sample. We observed an increase in the adjusted odds of PPH during July through September (adjusted odds ratios (AOR), 1.05; confidence interval (CI), 1.02–1.10) and October through December (AOR, 1.07; CI, 1.04–1.12) compared to the second half of the academic year (January to June). Conclusions This study showed a significant “July effect” concerning PPH. However, given the mixed results concerning maternal outcomes at the time of childbirth other than PPH, more research is needed to investigate the “July effect” on the outcomes of the third stage of labor. This study’s findings have important implications for patient safety interventions concerning MCH.
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Affiliation(s)
- Zahra Shahin
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, GA 30458, USA
- Correspondence:
| | - Gulzar H. Shah
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, GA 30458, USA
| | - Bettye A. Apenteng
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, GA 30458, USA
| | - Kristie Waterfield
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, GA 30458, USA
| | - Hani Samawi
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, GA 30458, USA
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Post-ERCP Pancreatitis: Prevention, Diagnosis and Management. Medicina (B Aires) 2022; 58:medicina58091261. [PMID: 36143938 PMCID: PMC9502657 DOI: 10.3390/medicina58091261] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) carries a post-ERCP pancreatitis (PEP) rate of 2–10%, which could be as high as 30–50% in high-risk cases. PEP is severe in up to 5% of cases, with potential for life-threatening complications, including multi-organ failure, peripancreatic fluid collections, and death in up to 1% of cases. The risk of PEP is potentially predictable and may be modified with pharmacological measures and endoscopist technique. This review covers the definition, epidemiology and risk factors for PEP, with a focus on the latest evidence-based medical and endoscopic strategies to prevent and manage PEP.
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Hutfless S, Shiratori Y, Chu D, Liu S, Kalloo A. Risk factors for infections after endoscopic retrograde cholangiopancreatography (ERCP): a retrospective cohort analysis of US Medicare Fee-For-Service claims, 2015-2021. BMJ Open 2022; 12:e065077. [PMID: 36691191 PMCID: PMC9472111 DOI: 10.1136/bmjopen-2022-065077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/24/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Contaminated reprocessed duodenoscopes pose a serious threat to patients in the endoscopy unit. Despite manufacturer changes to reprocessing guidelines, 20% of reprocessed duodenoscopes meet criteria for quarantine-level contamination based on microbiological or ATP testing. We aimed to examine risk factors for postendoscopic retrograde cholangiopancreatography (ERCP) infection. DESIGN Retrospective cohort analysis. SETTING US Medicare Fee-For-Service claims (2015-2021) and all-payer data (2017). PARTICIPANTS In the Medicare data, 823 575 ERCP procedures were included. The all-payer five-state data, 16 609 procedures were included. INTERVENTIONS ERCP was identified by Current Procedural Terminology and International Classification of Disease (ICD) procedure codes. We identified inpatient infections using ICD diagnosis codes. OUTCOME MEASURES A logistic regression model predicted risk factors for infections occurring within 7-day and 30-day periods following ERCP. 7-day and 30-day all-cause hospitalisations and post-ERCP pancreatitis were also examined. RESULTS Post-ERCP infection occurred within 3.5% of 7-day and 7.7% of 30-day periods in Medicare. Disposable duodenoscopes were billed in 711 procedures, with 1.4% (n=10, 7-day) and 3.5% (n=25, 30-day) post-ERCP infections. Urgent ERCPs were the strongest risk factor for infections in the 7-day period (OR 3.3, 95% CI 3.2 to 3.4). Chronic conditions, sex (male), age (older) and race (non-white) were also risk factors. In the all-payer five-state data, fewer infections (2.4%, 7 days) were observed. No difference arose between Medicare and other payers for 7-day period infections (OR 1.0, 95% CI 0.7 to 1.3). CONCLUSIONS Urgent ERCPs, patient chronic conditions and patient demographics are post-ERCP infection risk factors. Patients with infection risk factors should be targeted for specialised infection control prevention measures, including disposable duodenoscopes.
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Affiliation(s)
| | | | - Daniel Chu
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Simon Liu
- Johns Hopkins University, Baltimore, Maryland, USA
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Vedantam S, Amin S, Maher B, Ahmad S, Kadir S, Niaz SK, Wright M, Tehami N. Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training? Clin Endosc 2022; 55:426-433. [PMID: 35114744 PMCID: PMC9178142 DOI: 10.5946/ce.2021.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/AIMS Cholangiogram interpretation is not used as a key performance indicator (KPI) of endoscopic retrograde cholangiopancreatography (ERCP) training, and national societies recommend different minimum numbers per annum to maintain competence. This study aimed to determine the relationship between correct ERCP cholangiogram interpretation and experience. METHODS One hundred fifty ERCPists were surveyed to appropriately interpret ERCP cholangiographic findings. There were three groups of 50 participants each: "Trainees," "Consultants group 1" (performed >75 ERCPs per year), and "Consultants group 2" (performed >100 ERCPs per year). RESULTS Trainees was inferior to Consultants groups 1 and 2 in identifying all findings except choledocholithiasis outside the intrahepatic duct on the initial or completion/occlusion cholangiogram. Consultants group 1 was inferior to Consultants group 2 in identifying Strasberg type A bile leaks (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.77-0.96), Strasberg type B (OR, 0.84; 95% CI, 0.74-0.95), and Bismuth type 2 hilar strictures (OR, 0.81; 95% CI, 0.69-0.95). CONCLUSION This investigation supports the notion that cholangiogram interpretation improves with increased annual ERCP case volumes. Thus, a higher annual volume of procedures performed may improve the ability to correctly interpret particularly difficult findings. Cholangiogram interpretation, in addition to bile duct cannulation, could be considered as another KPI of ERCP training.
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Affiliation(s)
- Shyam Vedantam
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Sunil Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, Miami, FL, USA
| | - Ben Maher
- Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Saqib Ahmad
- Department of Gastroenterology, Sherwood Forest Hospitals NHS Foundation Trust, Sutton in Ashfield, UK
| | - Shanil Kadir
- Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Saad Khalid Niaz
- Interventional Endoscopy Unit, Surgical Unit 4, Dow University of Health Sciences, Karachi, Pakistan
| | - Mark Wright
- Southampton Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nadeem Tehami
- Southampton Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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YILMAZ H, KOÇYİĞİT B. Predictors of postendoscopic retrograde cholangiopancreatography associated cholangitis: a retrospective cohort study. Turk J Med Sci 2022; 52:105-112. [PMID: 36161594 PMCID: PMC10734888 DOI: 10.3906/sag-2109-84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/22/2022] [Accepted: 01/23/2022] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Post-ERCP cholangitis (endoscopic retrograde cholangiopancreatography) and associated sepsis can be lifethreatening. Despite the wealth of studies on post-ERCP pancreatitis risk factors, there is limited data on post-ERCP cholangitis. This study aimed to investigate the rates, predictors, and outcomes of post-ERCP cholangitis. METHODS A retrospective review of 452 ERCP cases performed by a single endoscopist at a tertiary center between March 2019 and February 2021 was performed. Patient-related, organizational and periprocedural factors that could affect post-ERCP cholangitis were evaluated. Predictors of post-ERCP cholangitis were determined by multivariable analysis. RESULTS The post-ERCP cholangitis rate was 19.5%. Cholangiocarcinoma (OR 15.72, CI 2.43-101.55, p = 0.004), the American Society of Anesthesiologist Score (ASA) (OR 2.87, CI 1.14-7.21, p = 0.024), an increase in bilirubin after ERCP (OR 1.81 CI 1.01-3.22, p = 0.043), body mass index (OR 1.15, CI 1.00-1.33, p = 0.04) and procedure duration (OR 1.02, CI 1.00-1.05, p = 0.049) were predictors of post-ERCP cholangitis. Biliary stone extraction using a balloon was found to be protective against cholangitis (OR 0.18, CI 0.05-0.60, p = 0.005). Sepsis rate related to post-ERCP cholangitis was 2.4% and death 1%.
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Affiliation(s)
- Hasan YILMAZ
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University, Kocaeli,
Turkey
| | - Burcu KOÇYİĞİT
- Department of Internal Medicine, Faculty of Medicine, Kocaeli University, Kocaeli,
Turkey
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Thompson L, Lin F, Faithfull-Byrne A, Gonzalez J, Naumann A, Geisler K, Moss C. Clinical coaches and patient safety - Just in time: A descriptive exploratory study. Nurse Educ Pract 2021; 54:103134. [PMID: 34256213 DOI: 10.1016/j.nepr.2021.103134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
Patient safety in hospitals is a key priority. Clinical coaches who educate, support and coach staff to deliver safe, high quality care, are ideally placed to positively influence patient safety. AIM This study aimed to understand how clinical coaches in an education role, manage risk and support patient safety at the point of care. BACKGROUND Patient safety has developed from a find and fix reactive model towards an approach which focuses on human performance, aiming to understand how individuals adapt and respond in complex systems to ensure 'things go right'. Clinical coaches working as educators at the point of care, are uniquely placed to ensure 'things go right', supporting staff to anticipate and proactively respond to emerging issues, particularly when complex practice situations change unexpectedly. Clinical coach experiences of intervening 'just in time' to prevent errors incidents or omissions occurring at the point of care is unknown. DESIGN This was a descriptive exploratory study conducted with registered nurses working in the role of clinical coach (n = 29). METHODS Study data were collected through a purposefully designed survey. RESULTS Clinical coaches intervened 'just in time' across a variety of clinical situations including medication errors, clinical procedures, documentation, assessment skills and clinical handover. Lower skill mix, higher patient acuity and the commencement of new staff influenced clinical coach 'just in time' interventions. Most of the clinical coaches had intervened with both junior and senior members of staff. Overall, clinical coaches spent up to 3-4 h every day proactively managing risk across a variety of clinical situations and staff. CONCLUSIONS Clinical coaches play an important role in ensuring patient safety by regularly intervening 'just in time' to prevent errors, omissions, or incidents from occurring at the point of care. The clinical coach role, which educates and supports staff to deliver safe, high quality care, makes a valuable contribution towards patient safety.
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Affiliation(s)
- Lorraine Thompson
- Practice Development, Sunshine Coast Hospital and Health Service (SCHHS), 6 Doherty St, Birtinya, Queensland 4575, Australia.
| | - Frances Lin
- School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, Sippy Downs drive, Queensland 4556, Australia; Sunshine Coast Health Institute, 6 Doherty St, Birtinya, Queensland 4575, Australia.
| | - Annette Faithfull-Byrne
- Practice Development, Sunshine Coast Hospital and Health Service (SCHHS), 6 Doherty St, Birtinya, Queensland 4575, Australia.
| | - Judith Gonzalez
- Practice Development, Sunshine Coast Hospital and Health Service (SCHHS), 6 Doherty St, Birtinya, Queensland 4575, Australia.
| | - Amanda Naumann
- Practice Development, Sunshine Coast Hospital and Health Service (SCHHS), 6 Doherty St, Birtinya, Queensland 4575, Australia.
| | - Kathryn Geisler
- Practice Development, Sunshine Coast Hospital and Health Service (SCHHS), 6 Doherty St, Birtinya, Queensland 4575, Australia.
| | - Cheryle Moss
- Nursing & Midwifery, Monash University, Victoria 3800, Australia.
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Lee TY, Nakai Y. Is the July Effect Real in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography? Clin Endosc 2019; 52:399-400. [PMID: 31344767 PMCID: PMC6785417 DOI: 10.5946/ce.2019.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Tae Yoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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