Queue position in the endoscopic schedule impacts effectiveness of colonoscopy

Alexander Lee, John M. Iskander, Nitin Gupta, Brian B. Borg, Gary Zuckerman, Bhaskar Banerjee, C. Prakash Gyawali

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Objectives: Endoscopist fatigue potentially impacts colonoscopy. Fatigue is difficult to quantitate, but polyp detection rates between non-fatigued and fatigued time periods could represent a surrogate marker. We assessed whether timing variables impacted polyp detection rates at a busy tertiary care endoscopy suite. Methods: Consecutive patients undergoing colonoscopy were retrospectively identified. Indications, clinical demographics, pre-procedural, and procedural variables were extracted from chart review; colonoscopy findings were determined from the procedure reports. Three separate timing variables were assessed as surrogate markers for endoscopist fatigue: morning vs. afternoon procedures, start times throughout the day, and queue position, a unique variable that takes into account the number of procedures performed before the colonoscopy of interest. Univariate and multivariate analyses were performed to determine whether timing variables and other clinical, pre-procedural, and procedural variables predicted polyp detection. Results: During the 4-month study period, 1,083 outpatient colonoscopy procedures (57.5±0.5 years, 59.5% female) were identified, performed by 28 endoscopists (mean 38.7 procedures/endoscopist), with a mean polyp detection rate of 0.851/colonoscopy. At least, one adenoma was detected in 297 procedures (27.4%). A 12.4% reduction in mean detected polyps was detected between morning and afternoon procedures (0.90±0.06 vs. 0.76±0.06, P=0.15). Using start time on a continuous scale, however, each elapsed hour in the day was associated with a 4.6% reduction in polyp detection (P=0.005). When queue position was assessed, a 5.4% reduction in polyp detection was noted with each increase in queue position (P=0.016). These results remained significant when controlled for each individual endoscopist. Conclusions: Polyp detection rates decline as time passes during an endoscopist's schedule, potentially from endoscopist fatigue. Queue position may be a novel surrogate measure for operator fatigue.

Original languageEnglish (US)
Pages (from-to)1457-1465
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume106
Issue number8
DOIs
StatePublished - Aug 2011
Externally publishedYes

Fingerprint

Colonoscopy
Polyps
Appointments and Schedules
Fatigue
Biomarkers
Tertiary Healthcare
Adenoma
Endoscopy
Outpatients
Multivariate Analysis
Demography

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Lee, A., Iskander, J. M., Gupta, N., Borg, B. B., Zuckerman, G., Banerjee, B., & Gyawali, C. P. (2011). Queue position in the endoscopic schedule impacts effectiveness of colonoscopy. American Journal of Gastroenterology, 106(8), 1457-1465. https://doi.org/10.1038/ajg.2011.87

Queue position in the endoscopic schedule impacts effectiveness of colonoscopy. / Lee, Alexander; Iskander, John M.; Gupta, Nitin; Borg, Brian B.; Zuckerman, Gary; Banerjee, Bhaskar; Gyawali, C. Prakash.

In: American Journal of Gastroenterology, Vol. 106, No. 8, 08.2011, p. 1457-1465.

Research output: Contribution to journalArticle

Lee, A, Iskander, JM, Gupta, N, Borg, BB, Zuckerman, G, Banerjee, B & Gyawali, CP 2011, 'Queue position in the endoscopic schedule impacts effectiveness of colonoscopy', American Journal of Gastroenterology, vol. 106, no. 8, pp. 1457-1465. https://doi.org/10.1038/ajg.2011.87
Lee, Alexander ; Iskander, John M. ; Gupta, Nitin ; Borg, Brian B. ; Zuckerman, Gary ; Banerjee, Bhaskar ; Gyawali, C. Prakash. / Queue position in the endoscopic schedule impacts effectiveness of colonoscopy. In: American Journal of Gastroenterology. 2011 ; Vol. 106, No. 8. pp. 1457-1465.
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abstract = "Objectives: Endoscopist fatigue potentially impacts colonoscopy. Fatigue is difficult to quantitate, but polyp detection rates between non-fatigued and fatigued time periods could represent a surrogate marker. We assessed whether timing variables impacted polyp detection rates at a busy tertiary care endoscopy suite. Methods: Consecutive patients undergoing colonoscopy were retrospectively identified. Indications, clinical demographics, pre-procedural, and procedural variables were extracted from chart review; colonoscopy findings were determined from the procedure reports. Three separate timing variables were assessed as surrogate markers for endoscopist fatigue: morning vs. afternoon procedures, start times throughout the day, and queue position, a unique variable that takes into account the number of procedures performed before the colonoscopy of interest. Univariate and multivariate analyses were performed to determine whether timing variables and other clinical, pre-procedural, and procedural variables predicted polyp detection. Results: During the 4-month study period, 1,083 outpatient colonoscopy procedures (57.5±0.5 years, 59.5{\%} female) were identified, performed by 28 endoscopists (mean 38.7 procedures/endoscopist), with a mean polyp detection rate of 0.851/colonoscopy. At least, one adenoma was detected in 297 procedures (27.4{\%}). A 12.4{\%} reduction in mean detected polyps was detected between morning and afternoon procedures (0.90±0.06 vs. 0.76±0.06, P=0.15). Using start time on a continuous scale, however, each elapsed hour in the day was associated with a 4.6{\%} reduction in polyp detection (P=0.005). When queue position was assessed, a 5.4{\%} reduction in polyp detection was noted with each increase in queue position (P=0.016). These results remained significant when controlled for each individual endoscopist. Conclusions: Polyp detection rates decline as time passes during an endoscopist's schedule, potentially from endoscopist fatigue. Queue position may be a novel surrogate measure for operator fatigue.",
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