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.
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.
Authors: Douglas K Rex; John H Bond; Sidney Winawer; Theodore R Levin; Randall W Burt; David A Johnson; Lynne M Kirk; Scott Litlin; David A Lieberman; Jerome D Waye; James Church; John B Marshall; Robert H Riddell Journal: Am J Gastroenterol Date: 2002-06 Impact factor: 10.864
Authors: Brian J Eastridge; Elizabeth C Hamilton; Grant E O'Keefe; Robert V Rege; Rawson J Valentine; Daniel J Jones; Seifu Tesfay; Erwin R Thal Journal: Am J Surg Date: 2003-08 Impact factor: 2.565
Authors: Kathryn L Lynch; Dennis J Ahnen; Tim Byers; David G Weiss; David A Lieberman Journal: Clin Gastroenterol Hepatol Date: 2003-03 Impact factor: 11.382
Authors: D K Rex; G A Lehman; T M Ulbright; J J Smith; D C Pound; R H Hawes; D J Helper; M J Wiersema; C D Langefeld; W Li Journal: Am J Gastroenterol Date: 1993-06 Impact factor: 10.864
Authors: Scott R Steele; Eric K Johnson; Bradley Champagne; Brad Davis; Sang Lee; David Rivadeneira; Howard Ross; Dana A Hayden; Justin A Maykel Journal: World J Gastroenterol Date: 2013-07-21 Impact factor: 5.742
Authors: Alexander Lee; Christopher D Jensen; Amy R Marks; Wei K Zhao; Chyke A Doubeni; Ann G Zauber; Virginia P Quinn; Theodore R Levin; Douglas A Corley Journal: Gastrointest Endosc Date: 2016-10-01 Impact factor: 9.427
Authors: Kenan W Yount; Christine L Lau; Leora T Yarboro; Ravi K Ghanta; Irving L Kron; John A Kern; Gorav Ailawadi Journal: Ann Thorac Surg Date: 2015-07-21 Impact factor: 4.330
Authors: Cassandra D L Fritz; Zachary L Smith; Jeffrey Elsner; Thomas Hollander; Dayna Early; Vladimir Kushnir Journal: Dig Dis Sci Date: 2018-05-03 Impact factor: 3.199