Does Trainee Involvement in Fluoroscopic Injections Affect Fluoroscopic Time, Immediate Pain Reduction, and...

Area of Science:

• Interventional Pain Management
• Medical Education
• Patient Safety

Background:

• Patient apprehension exists regarding procedures involving trainees, even with direct supervision.
• Limited research addresses the impact of trainee participation on patient outcomes.

Purpose of the Study:

• To assess trainee involvement's effect on patient complications.
• To evaluate trainee involvement's impact on immediate pain reduction.
• To determine trainee involvement's influence on fluoroscopic time for various injection types.

Main Methods:

• Retrospective review of fluoroscopically guided injections (hip, sacroiliac joint, transforaminal epidural, interlaminar epidural) across four academic institutions (2000-2015).
• Outcome measures analyzed included immediate complications, fluoroscopic time per injection (FTPI), and immediate pain improvement.
• Comparison of outcomes based on the presence or absence of a trainee during the procedure.

Main Results:

• Trainees participated in 67% of the 7,833 analyzed injections.
• No significant differences in complication rates or pain improvement were observed with trainee involvement.
• Increased FTPI was noted for interlaminar epidural injections (ILEIs) with trainees, but not for hip (HI) or sacroiliac joint injections (SIJIs).
• FTPI for transforaminal epidural injections (TFEIs) varied by institution but showed no significant increase with trainee involvement.

Conclusions:

• Trainee involvement in fluoroscopically guided injections does not adversely affect immediate patient complications or pain outcomes.
• Fluoroscopic time is generally not increased by trainee involvement, with some institutional variations noted.
• Appropriate supervision of trainees during these procedures supports patient safety.