title: Patient Safety Risks of Basic Urological Procedures Performed by Junior and Senior Residents.
abstract: OBJECTIVE
  To investigate the current performance of urological residents regarding basic urological procedures in relation to patient safety issues and the identification of specific training needs.
  
  
  METHODS
  Observational data of 146 urethrocystoscopies (UCSs), 27 transrectal ultrasounds of the prostate (TRUSs), 38 transrectal ultrasound-guided prostatic biopsies (TRUSPs), and 30 transurethral resections of bladder tumor (TURBTs) were collected. Performance was evaluated using scoring lists including details on completeness of procedural steps, level of independence, time, and the incidence of unintended events. The causal factors contributing to the unintended events were identified by 2 expert urologists and classified according to the recognized PRISMA method.
  
  
  METHODS
  This study was performed in 5 teaching hospitals in the Netherlands.
  
  
  METHODS
  We included 11 junior residents and 5 senior residents in urology in the final study cohort.
  
  
  RESULTS
  Senior residents showed a lower degree of completeness in material usage than junior residents did during UCS (p < 0.01) and in preparation, material usage, and procedure during TRUSP (all p < 0.05). In UCS and TURBT, senior residents received significantly less feedback than junior residents did (both p < 0.01). Incidence of unintended events for junior vs senior residents was 11% and 4% in UCS, 0% and 7% in transrectal ultrasound of the prostate, 36% and 62% in TRUSP, and 41% and 23% in TURBT, respectively. Overall, unintended events were mainly caused by human factors, in particular, verification and skills-based issues.
  
  
  CONCLUSIONS
  Present performance of basic urological procedures involves a high percentage of unintended events, especially in TRUSP and TURBT, which are mainly caused by human factors and are a potential threat for patient safety. Junior residents are less independent but more thorough in the performance of UCS and TRUSP than senior residents are. Targeted skills training including assessment should be implemented before privileges for independent practice are granted to reduce the incidence of unintended events and optimize patient safety.
authors.affiliation: Department of Urology, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: a.h.de.vries@hotmail.com.
authors.forename: Anna H
authors.initials: AH
authors.lastname: de Vries
authors.affiliation: Department of Surgery, Westfriesgasthuis, Hoorn, The Netherlands.
authors.forename: Maaike C
authors.initials: MC
authors.lastname: Boute
authors.affiliation: Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Malou C P
authors.initials: MC
authors.lastname: Kuppen
authors.affiliation: Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Jeroen J G
authors.initials: JJ
authors.lastname: van Merriënboer
authors.affiliation: Department of Urology, Catharina Hospital, Eindhoven, The Netherlands; Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Evert L
authors.initials: EL
authors.lastname: Koldewijn
authors.affiliation: Department of Urology, University Medical Center Leiden, Leiden, The Netherlands.
authors.forename: Rob C M
authors.initials: RC
authors.lastname: Pelger
authors.affiliation: Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands; Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
authors.forename: Barbara M A
authors.initials: BM
authors.lastname: Schout
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands; Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
mesh_terms: D002983:Clinical Competence; D004503:Education, Medical, Graduate; D006801:Humans; D007396:Internship and Residency; D009426:Netherlands; D061214:Patient Safety; D013647:Task Performance and Analysis; D013520:Urologic Surgical Procedures / Q000193:education*
keywords: Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; adverse event; patient safety; practical skills training; resident; task performance; urology