High mental workload negatively affects colonoscopy performance

Excessive mental workload experienced during colonoscopy was associated with a number of detrimental effects on endoscopists’ performance, according to data presented at the British Society of Gastroenterology Annual Meeting.

Studies have shown that health professionals who experience excessive workloads and fatigue show reduced performance, but research on how mental workload affects the performance of endoscopists has been neglected, the researchers wrote. They therefore sought to measure the mental workload of endoscopists using the NASA-Task Load Index and assess its effects on colonoscopy performance relative to the endoscopists’ experience and scheduling of the colonoscopy.

They prospectively evaluated 202 colonoscopies performed by six endoscopists at the University Hospital Southampton in the U.K. The endoscopists included trainees, consultants and bowel cancer specialist program endoscopists, who recorded mental demand, physical demand, temporal demand, effort, frustration and their own performance upon reaching the cecum during the procedure. Cecal intubation times, patient comfort, polyp detection rates, withdrawal times, time of day and queue order for procedures were also recorded.

The mean cecal intubation time was 9.2 minutes and the polyp detection rate was 42%. The researchers found that increasing mental workload was associated with increasing cecal intubation time (r = 0.61; P = .07) and was inversely associated with withdrawal time (r = –0.72; P = .03). Bowel cancer specialist program endoscopists had lower mean mental workload during colonoscopy (188) compared with consultants (254) and trainees (352; P < .01).

Multivariate analysis showed associations between absence of polyp detection and afternoon procedures with an above average mental workload (OR = 1.62; 95% CI, 1.38-2.07) and withdrawal times less than 5 minutes (OR = 1.53; 95% CI, 1.32-1.91). Moreover, increased patient discomfort was associated with increased frustration (OR = 1.59; 95% CI, 1.37-1.93) and being a trainee endoscopist (OR = 1.11; 95% CI, 1.03-1.22).

Consultants experienced reduced mental workload when using ScopeGuide (227 vs. 282; P < .01), while trainees and experts did not. Performance was not affected by queue position.

The researchers concluded that their findings indicate high mental workload significantly impacts endoscopist performance and that further research is needed to explore ways to reduce excessive mental workload.

Reduced polyp detection rates in afternoon procedures “when only associated with high mental workload may explain some of the conflicting results of daily variations of [polyp detection rates] in other studies,” they added. – by Adam Leitenberger

References:

Rahman I, et al. Abstract #OC-012. Presented at: British Society of Gastroenterology Annual Meeting; June 20-23, 2016; Liverpool, U.K.

Disclosures: The researchers report no relevant financial disclosures.