title: Recording ERCP fluoroscopy metrics using a multinational quality network: establishing benchmarks and examining time-related improvements.
abstract: OBJECTIVE
  We aimed to establish benchmarks for fluoroscopy time (FT) in endoscopic retrograde cholangiopancreatography (ERCP) and assess the effect of physician practice networking on time trends.
  
  
  METHODS
  Data from the ERCP Quality Network were used to assess practice variability in FT and establish case- and provider-level benchmarks of the first 200 cases for providers entering more than 100 cases. Trends in FT and high FT, by 50-patient groupings, were assessed by multilevel multivariate linear and logistic regression models.
  
  
  RESULTS
  Median FT was 2.9 minutes, averaging 16% of procedure time. Ninetieth percentiles for the 57 eligible providers were 10 minutes and 22% (n = 9, 185 ERCP). Every 50 cases entered was associated with lower FT. In multivariate analysis, more cases entered, higher lifetime and annual volumes, lower difficulty grade, and manometry had lower FTs; academics, trainee involvement, various therapeutics, and failed cannulation had higher FTs.
  
  
  CONCLUSIONS
  FT is highly variable, and many provider and case factors predict FT. FT benchmarks are now available. Self-review of one's case FT might decrease FT.
authors.affiliation: Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC 29425, USA. romagnuo@musc.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Romagnuolo
authors.forename: Peter B
authors.initials: PB
authors.lastname: Cotton
mesh_terms: D019985:Benchmarking; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000592:standards* / Q000706:statistics & numerical data*; D005471:Fluoroscopy / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D058996:Quality Improvement; D012044:Regression Analysis