Evaluation of an educational intervention to improve colonoscopy quality in St. John's, NL

Evans, Bradley (2019) Evaluation of an educational intervention to improve colonoscopy quality in St. John's, NL. Masters thesis, Memorial University of Newfoundland.

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Abstract

The Canadian Association of Gastroenterology (CAG) implemented the Colonoscopy Skills Improvement (CSI) program across Canada with the goal of improving colonoscopy quality. The objective of this study was to assess the impact of the CSI program on colonoscopy quality in St. John's, NL. Nineteen endoscopists practicing in a tertiary referral centre who have participated in CSI training since October 2014 were evaluated. For each endoscopist fifty consecutive procedures immediately before, immediately after, and eight months following CSI training were included. The primary outcome was change in adenoma detection rate (ADR). Secondary outcomes included number of adenomas detected per colonoscopy (APC), cecal intubation rate, and sedative usage and dosing. Patient characteristics were similar between time points. ADR did not significantly improve immediately after CSI training (31.8% v. 33.6%, p=0.484) or at the eight-month assessment (31.8% v. 35.3% p=0.107). There was no significant change in APC or completion rate at any time point. There was a statistically significant decrease in the average dose of Fentanyl (72.8mcg v. 64.8mcg v. 63.5mcg, p<0.001) and Midazolam (2.49mg v. 2.17mg v. 2.11, p<0.001) immediately after CSI training that persisted at eight months. Participation in the CSI program is not associated with change in ADR. CSI training is associated with decreased sedation dosing during colonoscopy.

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