Trainee inexperience is associated with longer procedure times but no increase in complications for cardiac device implantation
Background The “July phenomenon” describes poor patient outcomes in teaching hospitals at the beginning of a new academic year when trainees begin. Whether this phenomenon truly exists is unclear. Objective The purpose of this study was to identify whether trainee and attending inexperience is assoc...
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| Veröffentlicht in: | Heart rhythm 2013-12, Vol.10 (12), p.1755-1758 |
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| creator | Soleimani Rahbar, Ata, MD Hsu, Jonathan C., MD, MAS Han, Frederick T., MD Nguyen, NhuNhu, BA Kwon, Minkyung, MD Azadani, Peyman N., MD Marcus, Gregory M., MD, MAS, FHRS Lee, Byron K., MD, MAS |
| description | Background The “July phenomenon” describes poor patient outcomes in teaching hospitals at the beginning of a new academic year when trainees begin. Whether this phenomenon truly exists is unclear. Objective The purpose of this study was to identify whether trainee and attending inexperience is associated with cardiac electrophysiologic procedural outcomes including total procedure time, fluoroscopy time, and complications. Methods We retrospectively reviewed the available electronic records of 488 consecutive patients undergoing initial dual-chamber pacemaker (PM) or cardiac resynchronization therapy (CRT) device implantation performed at University of California, San Francisco from February 2004 through November 2011. We calculated physician’s year of experience using the procedure date and the physician’s job start date. Patients were stratified into two subgroups based on their device type. Procedural outcomes including procedure length, fluoroscopy time, and complications were retrieved from electronic databases. Results After multivariate analysis, fellow experience was associated with decreased procedure time (19% less procedure time/year of experience, 95% confidence interval [CI] 13%–25%, P |
| doi_str_mv | 10.1016/j.hrthm.2013.09.003 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1464892626</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1547527113009843</els_id><sourcerecordid>1464892626</sourcerecordid><originalsourceid>FETCH-LOGICAL-c414t-5e8194768480173a8f9cb7b5fe4870a4e45aa9be4c3fff0fe98202d893f806d3</originalsourceid><addsrcrecordid>eNqFkTuP1DAUhSMEYpeFX4CEXNIkXMeOYxcgoRUvaSUKprcc55rxkMSD7SxsxV_HmVkoaGj8kM859_q7VfWcQkOBileHZh_zfm5aoKwB1QCwB9Ul7TpRM9nTh9uZ93XX9vSiepLSAaBVAtjj6qLlJUAocVn92kXjF0RSlp9HjB4XWy6JmJSC9SbjSH74vCdTWL5iJMcYLI5rRJL9jIkMayZLKG4b0aQthtgwHydvTfZhScSFSKyJozeWjHjrt_TybpZ8EjytHjkzJXx2v19Vu_fvdtcf65vPHz5dv72pLac81x1KqngvJJdAe2akU3boh84hlz0YjrwzRg3ILXPOgUMlW2hHqZiTIEZ2Vb08x5b-v6-Ysp59sjiVPjCsSVMuuFStaEWRsrPUxpBSRKeP0c8m3mkKegOvD_oEXm_gNShdwBfXi_sC6zDj-Nfzh3QRvD4LsPzy1mPUyZ5gjz6izXoM_j8F3vzjt5NfCubpG95hOoQ1LgWgpjq1GvSXbfbb6CkDUJIz9hsZPa0C</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1464892626</pqid></control><display><type>article</type><title>Trainee inexperience is associated with longer procedure times but no increase in complications for cardiac device implantation</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Soleimani Rahbar, Ata, MD ; Hsu, Jonathan C., MD, MAS ; Han, Frederick T., MD ; Nguyen, NhuNhu, BA ; Kwon, Minkyung, MD ; Azadani, Peyman N., MD ; Marcus, Gregory M., MD, MAS, FHRS ; Lee, Byron K., MD, MAS</creator><creatorcontrib>Soleimani Rahbar, Ata, MD ; Hsu, Jonathan C., MD, MAS ; Han, Frederick T., MD ; Nguyen, NhuNhu, BA ; Kwon, Minkyung, MD ; Azadani, Peyman N., MD ; Marcus, Gregory M., MD, MAS, FHRS ; Lee, Byron K., MD, MAS</creatorcontrib><description>Background The “July phenomenon” describes poor patient outcomes in teaching hospitals at the beginning of a new academic year when trainees begin. Whether this phenomenon truly exists is unclear. Objective The purpose of this study was to identify whether trainee and attending inexperience is associated with cardiac electrophysiologic procedural outcomes including total procedure time, fluoroscopy time, and complications. Methods We retrospectively reviewed the available electronic records of 488 consecutive patients undergoing initial dual-chamber pacemaker (PM) or cardiac resynchronization therapy (CRT) device implantation performed at University of California, San Francisco from February 2004 through November 2011. We calculated physician’s year of experience using the procedure date and the physician’s job start date. Patients were stratified into two subgroups based on their device type. Procedural outcomes including procedure length, fluoroscopy time, and complications were retrieved from electronic databases. Results After multivariate analysis, fellow experience was associated with decreased procedure time (19% less procedure time/year of experience, 95% confidence interval [CI] 13%–25%, P <.001 in the PM subgroup; and 15% less procedure time/year of experience, 95% CI 7%–23%, P <.001 in the CRT subgroup). Fellow experience was associated with decreased fluoroscopy time in the CRT subgroup (19% less fluoroscopy time/experience years, 95% CI 5%–34%, P = .009). Neither fellow nor attending experience was associated with complications. Conclusion Each year of fellow experience is associated with a decrease in cardiac device implantation procedure time and a decrease in fluoroscopy time during CRT implantation. No associations between fellow experience and in-hospital complications were observed.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2013.09.003</identifier><identifier>PMID: 24016696</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; California - epidemiology ; Cardiac resynchronization therapy devices ; Cardiology - education ; Cardiovascular ; Clinical Competence - standards ; Defibrillators, Implantable ; Education, Medical, Continuing - standards ; Faculty - standards ; Fellowship ; Female ; Fluoroscopy ; Fluoroscopy - adverse effects ; Follow-Up Studies ; Heart Failure - therapy ; Hospitals, Teaching ; Humans ; Implantable cardioverter-defibrillator ; Incidence ; Male ; Middle Aged ; Operative Time ; Pacemaker ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Retrospective Studies ; Time Factors</subject><ispartof>Heart rhythm, 2013-12, Vol.10 (12), p.1755-1758</ispartof><rights>Heart Rhythm Society</rights><rights>2013 Heart Rhythm Society</rights><rights>2013 Heart Rhythm Society Published by Heart Rhythm Society All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-5e8194768480173a8f9cb7b5fe4870a4e45aa9be4c3fff0fe98202d893f806d3</citedby><cites>FETCH-LOGICAL-c414t-5e8194768480173a8f9cb7b5fe4870a4e45aa9be4c3fff0fe98202d893f806d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1547527113009843$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24016696$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Soleimani Rahbar, Ata, MD</creatorcontrib><creatorcontrib>Hsu, Jonathan C., MD, MAS</creatorcontrib><creatorcontrib>Han, Frederick T., MD</creatorcontrib><creatorcontrib>Nguyen, NhuNhu, BA</creatorcontrib><creatorcontrib>Kwon, Minkyung, MD</creatorcontrib><creatorcontrib>Azadani, Peyman N., MD</creatorcontrib><creatorcontrib>Marcus, Gregory M., MD, MAS, FHRS</creatorcontrib><creatorcontrib>Lee, Byron K., MD, MAS</creatorcontrib><title>Trainee inexperience is associated with longer procedure times but no increase in complications for cardiac device implantation</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Background The “July phenomenon” describes poor patient outcomes in teaching hospitals at the beginning of a new academic year when trainees begin. Whether this phenomenon truly exists is unclear. Objective The purpose of this study was to identify whether trainee and attending inexperience is associated with cardiac electrophysiologic procedural outcomes including total procedure time, fluoroscopy time, and complications. Methods We retrospectively reviewed the available electronic records of 488 consecutive patients undergoing initial dual-chamber pacemaker (PM) or cardiac resynchronization therapy (CRT) device implantation performed at University of California, San Francisco from February 2004 through November 2011. We calculated physician’s year of experience using the procedure date and the physician’s job start date. Patients were stratified into two subgroups based on their device type. Procedural outcomes including procedure length, fluoroscopy time, and complications were retrieved from electronic databases. Results After multivariate analysis, fellow experience was associated with decreased procedure time (19% less procedure time/year of experience, 95% confidence interval [CI] 13%–25%, P <.001 in the PM subgroup; and 15% less procedure time/year of experience, 95% CI 7%–23%, P <.001 in the CRT subgroup). Fellow experience was associated with decreased fluoroscopy time in the CRT subgroup (19% less fluoroscopy time/experience years, 95% CI 5%–34%, P = .009). Neither fellow nor attending experience was associated with complications. Conclusion Each year of fellow experience is associated with a decrease in cardiac device implantation procedure time and a decrease in fluoroscopy time during CRT implantation. No associations between fellow experience and in-hospital complications were observed.</description><subject>Aged</subject><subject>California - epidemiology</subject><subject>Cardiac resynchronization therapy devices</subject><subject>Cardiology - education</subject><subject>Cardiovascular</subject><subject>Clinical Competence - standards</subject><subject>Defibrillators, Implantable</subject><subject>Education, Medical, Continuing - standards</subject><subject>Faculty - standards</subject><subject>Fellowship</subject><subject>Female</subject><subject>Fluoroscopy</subject><subject>Fluoroscopy - adverse effects</subject><subject>Follow-Up Studies</subject><subject>Heart Failure - therapy</subject><subject>Hospitals, Teaching</subject><subject>Humans</subject><subject>Implantable cardioverter-defibrillator</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Operative Time</subject><subject>Pacemaker</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Retrospective Studies</subject><subject>Time Factors</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkTuP1DAUhSMEYpeFX4CEXNIkXMeOYxcgoRUvaSUKprcc55rxkMSD7SxsxV_HmVkoaGj8kM859_q7VfWcQkOBileHZh_zfm5aoKwB1QCwB9Ul7TpRM9nTh9uZ93XX9vSiepLSAaBVAtjj6qLlJUAocVn92kXjF0RSlp9HjB4XWy6JmJSC9SbjSH74vCdTWL5iJMcYLI5rRJL9jIkMayZLKG4b0aQthtgwHydvTfZhScSFSKyJozeWjHjrt_TybpZ8EjytHjkzJXx2v19Vu_fvdtcf65vPHz5dv72pLac81x1KqngvJJdAe2akU3boh84hlz0YjrwzRg3ILXPOgUMlW2hHqZiTIEZ2Vb08x5b-v6-Ysp59sjiVPjCsSVMuuFStaEWRsrPUxpBSRKeP0c8m3mkKegOvD_oEXm_gNShdwBfXi_sC6zDj-Nfzh3QRvD4LsPzy1mPUyZ5gjz6izXoM_j8F3vzjt5NfCubpG95hOoQ1LgWgpjq1GvSXbfbb6CkDUJIz9hsZPa0C</recordid><startdate>20131201</startdate><enddate>20131201</enddate><creator>Soleimani Rahbar, Ata, MD</creator><creator>Hsu, Jonathan C., MD, MAS</creator><creator>Han, Frederick T., MD</creator><creator>Nguyen, NhuNhu, BA</creator><creator>Kwon, Minkyung, MD</creator><creator>Azadani, Peyman N., MD</creator><creator>Marcus, Gregory M., MD, MAS, FHRS</creator><creator>Lee, Byron K., MD, MAS</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20131201</creationdate><title>Trainee inexperience is associated with longer procedure times but no increase in complications for cardiac device implantation</title><author>Soleimani Rahbar, Ata, MD ; Hsu, Jonathan C., MD, MAS ; Han, Frederick T., MD ; Nguyen, NhuNhu, BA ; Kwon, Minkyung, MD ; Azadani, Peyman N., MD ; Marcus, Gregory M., MD, MAS, FHRS ; Lee, Byron K., MD, MAS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-5e8194768480173a8f9cb7b5fe4870a4e45aa9be4c3fff0fe98202d893f806d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>California - epidemiology</topic><topic>Cardiac resynchronization therapy devices</topic><topic>Cardiology - education</topic><topic>Cardiovascular</topic><topic>Clinical Competence - standards</topic><topic>Defibrillators, Implantable</topic><topic>Education, Medical, Continuing - standards</topic><topic>Faculty - standards</topic><topic>Fellowship</topic><topic>Female</topic><topic>Fluoroscopy</topic><topic>Fluoroscopy - adverse effects</topic><topic>Follow-Up Studies</topic><topic>Heart Failure - therapy</topic><topic>Hospitals, Teaching</topic><topic>Humans</topic><topic>Implantable cardioverter-defibrillator</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Operative Time</topic><topic>Pacemaker</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Retrospective Studies</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Soleimani Rahbar, Ata, MD</creatorcontrib><creatorcontrib>Hsu, Jonathan C., MD, MAS</creatorcontrib><creatorcontrib>Han, Frederick T., MD</creatorcontrib><creatorcontrib>Nguyen, NhuNhu, BA</creatorcontrib><creatorcontrib>Kwon, Minkyung, MD</creatorcontrib><creatorcontrib>Azadani, Peyman N., MD</creatorcontrib><creatorcontrib>Marcus, Gregory M., MD, MAS, FHRS</creatorcontrib><creatorcontrib>Lee, Byron K., MD, MAS</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Soleimani Rahbar, Ata, MD</au><au>Hsu, Jonathan C., MD, MAS</au><au>Han, Frederick T., MD</au><au>Nguyen, NhuNhu, BA</au><au>Kwon, Minkyung, MD</au><au>Azadani, Peyman N., MD</au><au>Marcus, Gregory M., MD, MAS, FHRS</au><au>Lee, Byron K., MD, MAS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Trainee inexperience is associated with longer procedure times but no increase in complications for cardiac device implantation</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2013-12-01</date><risdate>2013</risdate><volume>10</volume><issue>12</issue><spage>1755</spage><epage>1758</epage><pages>1755-1758</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Background The “July phenomenon” describes poor patient outcomes in teaching hospitals at the beginning of a new academic year when trainees begin. Whether this phenomenon truly exists is unclear. Objective The purpose of this study was to identify whether trainee and attending inexperience is associated with cardiac electrophysiologic procedural outcomes including total procedure time, fluoroscopy time, and complications. Methods We retrospectively reviewed the available electronic records of 488 consecutive patients undergoing initial dual-chamber pacemaker (PM) or cardiac resynchronization therapy (CRT) device implantation performed at University of California, San Francisco from February 2004 through November 2011. We calculated physician’s year of experience using the procedure date and the physician’s job start date. Patients were stratified into two subgroups based on their device type. Procedural outcomes including procedure length, fluoroscopy time, and complications were retrieved from electronic databases. Results After multivariate analysis, fellow experience was associated with decreased procedure time (19% less procedure time/year of experience, 95% confidence interval [CI] 13%–25%, P <.001 in the PM subgroup; and 15% less procedure time/year of experience, 95% CI 7%–23%, P <.001 in the CRT subgroup). Fellow experience was associated with decreased fluoroscopy time in the CRT subgroup (19% less fluoroscopy time/experience years, 95% CI 5%–34%, P = .009). Neither fellow nor attending experience was associated with complications. Conclusion Each year of fellow experience is associated with a decrease in cardiac device implantation procedure time and a decrease in fluoroscopy time during CRT implantation. No associations between fellow experience and in-hospital complications were observed.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24016696</pmid><doi>10.1016/j.hrthm.2013.09.003</doi><tpages>4</tpages></addata></record> |
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| ispartof | Heart rhythm, 2013-12, Vol.10 (12), p.1755-1758 |
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| subjects | Aged California - epidemiology Cardiac resynchronization therapy devices Cardiology - education Cardiovascular Clinical Competence - standards Defibrillators, Implantable Education, Medical, Continuing - standards Faculty - standards Fellowship Female Fluoroscopy Fluoroscopy - adverse effects Follow-Up Studies Heart Failure - therapy Hospitals, Teaching Humans Implantable cardioverter-defibrillator Incidence Male Middle Aged Operative Time Pacemaker Postoperative Complications - epidemiology Postoperative Complications - etiology Retrospective Studies Time Factors |
| title | Trainee inexperience is associated with longer procedure times but no increase in complications for cardiac device implantation |
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