Impact of operator fatigue on endoscopy performance: implications for procedure scheduling

Area of Science:

• Gastroenterology
• Endoscopy
• Medical Quality Improvement

Background:

• Increasing demand for endoscopic procedures necessitates higher endoscopist workloads.
• Endoscopist fatigue is a potential concern impacting procedural quality.
• This study investigates the relationship between procedure order and endoscopy performance.

Purpose of the Study:

• To evaluate the impact of endoscopist fatigue on the quality of endoscopic procedures.
• To compare key performance indicators based on the chronological order of colonoscopies and esophagogastroduodenoscopies (EGDs).

Main Methods:

• Prospective observation of consecutive endoscopic procedures.
• Comparison of colonoscopy quality indicators (cecal intubation, lesion detection, withdrawal/insertion times) and EGD duration across procedure sequences.
• Analysis of outcomes based on chronological procedure order.

Main Results:

• Colonoscopy cecal intubation rates significantly decreased from 90% (procedures 1-3) to 76% (procedures 4+).
• Median colonoscopy insertion times tended to lengthen for later procedures (5th+ vs. 1st-4th).
• Lesion detection rates, withdrawal times, and EGD duration remained consistent regardless of procedure order.

Conclusions:

• Colonoscopy cecal intubation rates appear to decline with increasing procedure numbers.
• A trend towards longer insertion times was observed in later procedures.
• Key quality metrics like lesion detection and withdrawal time, along with EGD duration, were not adversely affected by procedural fatigue.