The measurement of sedation KPIs in colonoscopy varies between JETS certification criteria and recent UK standards. To align standards in preparation for the National Endoscopy Database (NED), changes were recently made on JETS: 1) measuring average sedation doses, when used, with mean vs. median, and 2) reducing the maximum recommended midazolam dose in patients aged 70+from mean of 2.5 mg to median of 2 mg. We aimed to explore the impact of these changes on trainee outcomes of exceeding recommended average doses.Methods
Sedation KPIs for midazolam [M], fentanyl [F] and pethidine [P] were extracted from the JETS e-Portfolios of trainees awarded provisional colonoscopy certification (PCC) between June 2011–2016, and stratified by drug and age (<70 vs. 70+). Calculations were applied at trainee level in the 50 procedures pre-PCC. Unsedated procedures were excluded. Normality testing was performed using the Shapiro-Wilk method, with skewed data expressed in medians and pairwise comparisons of KPI data made using Wilcoxon and McNemar’s tests.Results
733 trainees performed 36 650 procedures with M (75.6%), F (49.6%) and P (25.3%). Normality testing indicated the skewed distribution of sedation doses, which supported the use of medians. At trainee-level, changing mean to median resulted in smaller average doses of M, F and P for patients aged <70 and 70+ (figure 1), with lower estimates in 41.6%. Fewer trainees exceeded the 2.5 mg midazolam dose threshold in 70+ (table 1) when averaged with median (4.4%) vs. mean (8.1%) [p<0.001]. In this group, limiting the median M dose from 2.5 mg to 2 mg led to an increase in trainees failing to meet this standard (from 4.4% to 10.7%, p<0.001). Overall, the change of KPI measurement increased the proportion of trainees exceeding the new sedation threshold at PCC from 8.1% to 10.7% (p=0.010).Conclusions
The JETS sedation KPIs have aligned with UK standards. As this may affect trainee outcome, all colonoscopy trainees and trainers should take note and exercise caution with sedation use, particularly in elderly patients.