2015-12-07 22:08:37 UTC

Procedure Delays, Time of Day Do Not Affect Quality of Screening Colonoscopies

Dec. 8, 2015

Quality improvement should focus on optimizing skill, not on human factors such as fatigue and distraction.

There is growing literature regarding the role of human factors such as fatigue and distraction in procedure quality. Rajesh N. Keswani, MD, and colleagues studied the effects of human and system factors on screening colonoscopy withdrawal time and likelihood of detecting an adenoma in a large cohort of patients. Their findings, recently published online in Clinical Gastroenterology and Hepatology (CGH), show that procedure delays and measured factors associated with fatigue, including time of day and multiple procedure blocks, do not reduce the odds of detecting an adenoma.

In this study of 7,004 patients undergoing colonoscopy by 18 endoscopists, there was no association between delays in procedure start time on colonoscopy withdrawal time or odds of detecting an adenoma. There was also no association between increasing colonoscope insertion time and withdrawal time, or a decrease in adenoma detection. Furthermore, the researchers found no impact on increasing hour of day or performing two colonoscopy blocks in one day on withdrawal time or on the odds of detecting an adenoma.

This research suggests that future quality improvement efforts should focus mainly on optimizing physician skill using proven mechanisms to reduce intra-provider variation, such as education and report cards, in order to improve screening colonoscopy effectiveness.

Read the full study on the CGH website (login required).

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