Pediatric endoscopy across multiple clinical settings: Efficiency and adverse events

ARTICLE HIGHLIGHTS

Research background

There has been an increase in pediatric endoscopic procedures over time and an increased demand to perform them efficiently. These procedures are now being performed in more diverse clinical settings, from tertiary care operating rooms to ambulatory centers. Data is lacking with regards to safety and efficiency of these procedures across multiple clinical settings which is needed information as the pediatric endoscopic landscape diversifies.

Research motivation

We aimed to understand efficiency and adverse rate events of pediatric endoscopic procedures across multiple clinical settings as there is a paucity of this data in the literature. This research could help lay the foundation for guidelines of building outpatient pediatric endoscopy suites or ambulatory centers.

Research objectives

The main objective of our study was to evaluate the efficiency of endoscopic procedures performed by pediatric gastroenterologists in diverse clinical settings, particularly ambulatory centers as compared to a tertiary care operating room. We also assessed adverse events associated with endoscopic procedures performed across these clinical settings.

Research methods

A retrospective chart review was conducted of esophagogastroduodenoscopy (EGD) or combined EGD and colonoscopies performed over a 4 year period by 6 experienced gastroenterologists in three settings; a tertiary care hospital operating room, community hospital operating room, and a free-standing pediatric ambulatory endoscopy center at a community hospital. Demographics, times, admission rates and adverse events were collected and efficiency was measured in endoscopist time (elapsed time from the endoscopist entering the operating room or endoscopy suite to the next patient entering) and patient time (elapsed time from patient registration to that patient exiting the operating room or endoscopy suite). Statistical analyses were performed by a trained statistician and descriptive statistics were generated for each of the variables collected.

Research results

The majority of the cases were performed at the tertiary care operating room. Endoscopist time at the tertiary care operating room was 12 min longer compared to the community operating room (63.3 ± 21.5 min vs 51.4 ± 18.9 min; P < 0.001) and 7 min longer compared to the endoscopy center (vs 56.6 ± 19.3 min; P < 0.001). Patient time at the tertiary care operating room was 11 min longer compared to the community operating room (133.2 ± 39.9 min vs 122.3 ± 39.5 min; P < 0.001) and 9 min longer compared to the endoscopy center (vs 124.9 ± 37.9 min, P < 0.001). Adverse events occurred in 0.1% of cases performed in the tertiary care operating room.

Research conclusions

We found that it was more efficient to perform EGD and colonoscopies at a community hospital operating room and a free-standing pediatric ambulatory endoscopy center at a community hospital when compared to a tertiary care operating room in a select pediatric population. There was not an increased adverse event rate that we observed at these satellite locations when compared to the tertiary care operating room. Being able to perform these procedures safely and efficiently in multiple clinical settings may help meet the growing demand of endoscopic procedures in children.

Research perspectives

This research showed that pediatric endoscopic procedures are efficient in multiple clinical settings in a select pediatric population. Larger, prospective studies are needed to validate what we have found and to better assess safety. Our research could help lay the foundation for future guidelines on building efficient outpatient pediatric endoscopy suites.