A Checklist Improves Troubleshooting of Common Endoscopic Malfunctions By Surgical Residents in a Simulated Environment

Kevin L Grimes, MD, Jenny Lam, BS, Shawn Tsuda, MD

University of Nevada School of Medicine

INTRODUCTION
This study assessed the utility of a checklist in troubleshooting endoscopic equipment. Prior studies have demonstrated that performance in simulated tasks translates into completion of similar tasks in the operating room, and that simulation of low-frequency events may increase participants’ comfort in those situations. Checklists have also been shown to decrease error and improve patient safety. There is currently limited experience with the use of simulation and checklists to specifically improve troubleshooting of endoscopic equipment. We propose the use of a checklist during a simulated colonoscopy to improve performance during endoscopic troubleshooting.

METHODS
This study randomized 20 surgical residents (PGY 1-3) who were blinded to the purpose of the simulation. A mock endoscopy suite was created utilizing a colonoscopy model, a standard colonoscope, and an endoscopy tower (Olympus, Center Valley, PA). Participants were asked to complete two consecutive colonoscopies. Prior to each trial a standard set of equipment malfunctions were created; the equipment was returned to working order if the subjects were unable to successfully troubleshoot the equipment within the first 3 minutes of the simulation. Between trials, the intervention group was provided a troubleshooting checklist, which they were permitted to utilize during the second trial. The control group had no intervention. Performance was reviewed by expert endoscopists, and scores were calculated for each task by subtracting time to completion from total time allowed (180 seconds), with 0 indicating the task was not completed. Groups were compared utilizing unpaired Student’s t-test with p < 0.05 threshold for significance.

RESULTS
Average scores were compared for 5 tasks in the first trial and 6 tasks in the second trial (see tables below). During the first trial, there were no significant differences:

During the second trial, there was a significant improvement with the checklist for 5/6 tasks.

CONCLUSION
Use of a checklist, with no further intervention, significantly improves the ability of novice endoscopists to identify and remedy common equipment malfunctions. Introduction of a troubleshooting checklist provides a useful tool for training of surgical residents and may represent a simple and low-cost way to improve both efficiency and safety in the endoscopy suite.

Session: Poster Presentation

Program Number: P154