Anna H de Vries1, Maaike C Boute2, Malou C P Kuppen3, Jeroen J G van Merriënboer4, Evert L Koldewijn5, Rob C M Pelger6, Barbara M A Schout7, Cordula Wagner8. 1. Department of Urology, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: a.h.de.vries@hotmail.com. 2. Department of Surgery, Westfriesgasthuis, Hoorn, The Netherlands. 3. Department of Urology, Catharina Hospital, Eindhoven, The Netherlands. 4. Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands. 5. Department of Urology, Catharina Hospital, Eindhoven, The Netherlands; Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands. 6. Department of Urology, University Medical Center Leiden, Leiden, The Netherlands. 7. Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands; Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. 8. Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands; Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
Abstract
OBJECTIVE: To investigate the current performance of urological residents regarding basic urological procedures in relation to patient safety issues and the identification of specific training needs. DESIGN: Observational data of 146 urethrocystoscopies (UCSs), 27 transrectal ultrasounds of the prostate (TRUSs), 38 transrectal ultrasound-guided prostatic biopsies (TRUSPs), and 30 transurethral resections of bladder tumor (TURBTs) were collected. Performance was evaluated using scoring lists including details on completeness of procedural steps, level of independence, time, and the incidence of unintended events. The causal factors contributing to the unintended events were identified by 2 expert urologists and classified according to the recognized PRISMA method. SETTING: This study was performed in 5 teaching hospitals in the Netherlands. PARTICIPANTS: We included 11 junior residents and 5 senior residents in urology in the final study cohort. RESULTS: Senior residents showed a lower degree of completeness in material usage than junior residents did during UCS (p < 0.01) and in preparation, material usage, and procedure during TRUSP (all p < 0.05). In UCS and TURBT, senior residents received significantly less feedback than junior residents did (both p < 0.01). Incidence of unintended events for junior vs senior residents was 11% and 4% in UCS, 0% and 7% in transrectal ultrasound of the prostate, 36% and 62% in TRUSP, and 41% and 23% in TURBT, respectively. Overall, unintended events were mainly caused by human factors, in particular, verification and skills-based issues. CONCLUSION: Present performance of basic urological procedures involves a high percentage of unintended events, especially in TRUSP and TURBT, which are mainly caused by human factors and are a potential threat for patient safety. Junior residents are less independent but more thorough in the performance of UCS and TRUSP than senior residents are. Targeted skills training including assessment should be implemented before privileges for independent practice are granted to reduce the incidence of unintended events and optimize patient safety.
OBJECTIVE: To investigate the current performance of urological residents regarding basic urological procedures in relation to patient safety issues and the identification of specific training needs. DESIGN: Observational data of 146 urethrocystoscopies (UCSs), 27 transrectal ultrasounds of the prostate (TRUSs), 38 transrectal ultrasound-guided prostatic biopsies (TRUSPs), and 30 transurethral resections of bladder tumor (TURBTs) were collected. Performance was evaluated using scoring lists including details on completeness of procedural steps, level of independence, time, and the incidence of unintended events. The causal factors contributing to the unintended events were identified by 2 expert urologists and classified according to the recognized PRISMA method. SETTING: This study was performed in 5 teaching hospitals in the Netherlands. PARTICIPANTS: We included 11 junior residents and 5 senior residents in urology in the final study cohort. RESULTS: Senior residents showed a lower degree of completeness in material usage than junior residents did during UCS (p < 0.01) and in preparation, material usage, and procedure during TRUSP (all p < 0.05). In UCS and TURBT, senior residents received significantly less feedback than junior residents did (both p < 0.01). Incidence of unintended events for junior vs senior residents was 11% and 4% in UCS, 0% and 7% in transrectal ultrasound of the prostate, 36% and 62% in TRUSP, and 41% and 23% in TURBT, respectively. Overall, unintended events were mainly caused by human factors, in particular, verification and skills-based issues. CONCLUSION: Present performance of basic urological procedures involves a high percentage of unintended events, especially in TRUSP and TURBT, which are mainly caused by human factors and are a potential threat for patient safety. Junior residents are less independent but more thorough in the performance of UCS and TRUSP than senior residents are. Targeted skills training including assessment should be implemented before privileges for independent practice are granted to reduce the incidence of unintended events and optimize patient safety.
Authors: Lukasz Bialek; Slawomir Poletajew; Piotr Maciej Magusiak; Mikolaj Ostrach; Jakub Szpernalowski; Bartosz Dybowski; Piotr Radziszewski Journal: Turk J Urol Date: 2018-11-21
Authors: Anna H de Vries; Barbara M A Schout; Jeroen J G van Merriënboer; Rob C M Pelger; Evert L Koldewijn; Arno M M Muijtjens; Cordula Wagner Journal: Surg Endosc Date: 2016-07-07 Impact factor: 4.584