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Time of day, procedure delays do not reduce screening colonoscopy quality
Procedure delays and factors associated with physician fatigue, such as time of day, did not reduce the adenoma detection rate of screening colonoscopies, according to recent study data.
To evaluate whether factors beyond endoscopist skill affect screening colonoscopy quality, Rajesh N. Keswani, MD, from the division of gastroenterology at Northwestern University Feinberg School of Medicine, and colleagues performed a retrospective analysis of operational and quality improvement data on 7,004 screening colonoscopies performed by 18 endoscopists at a single academic medical center from November 2012 through February 2014.
Rajesh N. Keswani
“We hypothesized that delays in procedure start time and colonoscopy insertion time would be associated with reduced colonoscopy quality, potentially due to the endoscopist trying to ‘catch-up’ by decreasing withdrawal time,” the researchers wrote.
All endoscopists performed at least 100 screening colonoscopies over the study period and had been in practice for a median of 19 (range, 1-43) years. Patients were mostly women (56.2%) and had a median age of 57 years (IQR = 52-63 years). Bowel prep quality was mostly high (87.5%), and about 27% of procedures began on time, while 18.9% were delayed by more than 30 minutes. Median insertion time was 5.9 (IQR = 4-8.6) minutes.
The researchers performed multivariable logistic regression analysis adjusting for covariates and endoscopist-level clustering and found that withdrawal time was not significantly associated with procedure delays, time of day, increased insertion time or performing a procedure during the second of two colonoscopy blocks in the same day. Moreover, they found that the adenoma detection rate — which varied from 10.3% to 55.2% between endoscopists — was not significantly associated with procedure delays, time of day or performing a procedure during the second of two colonoscopy blocks in the same day. However, adenoma detection was more likely with an insertion time between 6.7 and 9.4 minutes (OR = 1.28; 95% CI, 1.1-1.5), but there was no consistent directional relationship.
“In summary, when accounting for provider variation, delayed procedure start times, increasing colonoscope insertion time, later queue position, and afternoon colonoscopy did not independently impact screening colonoscopy quality,” the researchers concluded. “As there is marked heterogeneity in adenoma detection rates between providers, quality improvement efforts should focus on proven mechanisms to reduce intra-provider variation, such as education and report cards to improve screening colonoscopy effectiveness.” – by Adam Leitenberger
Disclosures: Keswani reports he is a consultant for Boston Scientific and Cook Medical. All other authors report no relevant financial disclosures.