Impact of a Natural Disaster on Gastroenterology Fellow Colonoscopy Performance

Abstract

Purpose: Following the devastation of Hurricane Sandy, all three New York University (NYU) Hospital Centers (Manhattan Veterans Affairs Medical Center [VAMC], Bellevue Hospital Center and Langone Medical Center) were forced to temporarily shut down operations. During this time, all housestaff were systematically relocated to nearby hospitals in order to continue training. All Manhattan VAMC gastroenterology trainees were relocated to the Brooklyn VAMC. We compared the performance of gastroenterology trainees at their home site (Manhattan VAMC) prior to the disaster, with their performance after being transferred to the Brooklyn site after the disaster in order to assess the impact of a natural disaster and relocation on colonoscopy performance. The primary aim of our study was to examine the impact of relocation of gastroenterology trainees following the devastation caused by Hurricane Sandy on colonoscopy performance benchmarks. Methods: We studied 11 gastroenterology fellow trainees who performed a total of 202 colonoscopies prior to Hurricane Sandy and 175 colonoscopies after Hurricane Sandy, over a 5-month period. We analyzed differences in total colonoscopy procedure time, colonoscopy insertion time to cecum, colonoscopy withdrawal time, adenoma detection rate (ADR), cecal intubation rate, and the amount of sedation administered from pre-Hurricane Sandy and post-Hurricane Sandy procedures. Results: We compared the 202 colonoscopies performed by 11 gastroenterology fellows prior to Hurricane Sandy at the Manhattan VAMC with 175 colonoscopies performed by the same 11 gastroenterology fellows at the Brooklyn VAMC after the disaster. There were no differences in the sedation requirements for colonoscopies performed before or after the disaster. Still, the disaster seemed to have impacted colonoscopy performance as insertion time to cecum (15.48 min vs. 17.83 min; p=0.0089) and total procedure time (33.64 min vs. 36.24 min; p=0.0318) were significantly increased after the disaster, compared to before the disaster. Average withdrawal time (18.53 min vs. 18.63 min; p=0.5973) and ADR (38% vs. 37%; p=0.8308) were not impacted by displacement. Successful cecal intubation was achieved in 97% of the colonoscopies before relocation and in 94% of the colonoscopies after relocation (p=0.2078). Conclusion: In our study, the relocation of fellow trainees following Hurricane Sandy, a natural disaster which caused closure of the NYU Hospital Centers, was associated with longer insertion and total procedure times, but not cecal intubation rate or ADR. Whether performance was impacted by the stress of the disaster or unfamiliarity with working at an unfamiliar site will be explored.