Room for Quality Improvement in Endoscopist-Directed Sedation: Results from the First Nationwide Survey in Korea

Abstract

Background/AimsThis study sought to characterize the current sedation practices of Korean endoscopists in real-world settings.MethodsAll active members of the Korean Society of Gastrointestinal Endoscopy were invited to complete an anonymous 35-item questionnaire.ResultsThe overall response rate was 22.7% (1,332/5,860). Propofol-based sedation was the dominant method used in both elective esophagogastroduodenoscopy (55.6%) and colonoscopy (52.6%). The mean satisfaction score for propofol-based sedation was significantly higher than that for standard sedation in both examinations (all p<0.001). The use of propofol was supervised exclusively by endoscopists (98.6%). Endoscopists practicing in nonacademic settings, gastroenterologists, or endoscopists with <10 years of endoscopic practice were more likely to use propofol than were their counterparts (all p<0.001). In total, 27.3% of all respondents performed sedation practices without having undergone sedation training, and 27.4% did so without any formal sedation protocols. The choice of propofol as the dominant sedation method was the only significant predictor of endoscopist experience with serious sedation-related adverse events (odds ratio, 1.854; 95% confidence interval, 1.414 to 2.432).ConclusionsEndoscopist-directed propofol administration is the predominant sedation method used in Korea. This survey strongly suggests that there is much room for quality improvement regarding sedation training and patient vigilance in endoscopist-directed sedation.

Practice guidelines for propofol sedation by non-anesthesiologists: the Korean Society of Anesthesiologists Task Force recommendations on propofol sedation

“…However, in Korea, a considerable number of propofol sedations have been performed without independent monitoring by medical personnel [18]. Although the KSA fully supports the necessity of an additional staff member solely for propofol sedation for all procedures and patients, Recommendation 11 is graded as 'class IIb' due to low clinical applicability for prohibiting brief interruptions of monitoring by medical personnel.…”

National Endoscopy Quality Improvement Program Remains Suboptimal in Korea

“…In a recent nationwide survey from Korea,19 benzodiazepine was used in combination with propofol in 25.3% of EGDs and in 33.8% of colonoscopies, and propofol alone was used in 29.0% of EGDs and 6.0% of colonoscopies, respectively. It seems likely that higher participation of endoscopists from primary clinic in that study19 may be a possible explanation for higher preference for propofol use compared with our data. The widespread use of propofol for gastrointestinal endoscopy has also been documented in several European countries 20,21.…”

“…The widespread use of propofol for gastrointestinal endoscopy has also been documented in several European countries 20,21. As the characteristics of propofol include a rapid onset of action with a short-term effect, a shorter recovery time, and greater patient and endoscopist satisfaction,22 propofol use may be preferred by endoscopists practicing in primary clinic setting 19. Our survey findings suggested suboptimal performance of endoscopy reprocessing, as 28% of respondents used unapproved disinfectants or did not know main ingredient of their disinfectants as well as 15% to 17% of respondents did not follow reprocessing protocols 23.…”

Needs assessment survey for simulation‐based training for gastrointestinal endoscopy nurses

“…Gastrointestinal (GI) endoscopic services are easily accessible in Korea since the introduction of the national cancer screening program (Cho, ). In addition, endoscopist‐directed, nurse‐administered sedation is currently the dominant method used in routine GI endoscopy in Korea (Lee et al, ). However, GI endoscopy nurses have shown higher levels of stress than doctors because of high patient turnover rates and the ergonomic stresses involved in endoscopic procedures (Nam et al, ).…”

“…A compelling framework for continuing education in the workplace is competence‐based education (Goudreau et al, ), and training programs should be provided so that nurses can obtain the broad array of required competences. In addition, it is also necessary to assess nurses’ practices in line with standards (Beilenhoff & Neumann, ; Chan, Bond, Adamson, & Chow, ; Lee et al, ).…”