Queue position in the endoscopic schedule impacts effectiveness of colonoscopy.

Area of Science:

• Gastroenterology
• Endoscopy
• Medical Quality Improvement

Background:

• Endoscopist fatigue is a potential concern impacting colonoscopy quality.
• Quantifying fatigue is challenging, but polyp detection rates may serve as a surrogate marker.
• Understanding factors affecting polyp detection is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the impact of timing variables on polyp detection rates during colonoscopies.
• To assess whether endoscopist fatigue, indicated by procedural timing, affects the ability to detect polyps.
• To evaluate 'queue position' as a novel surrogate marker for endoscopist fatigue.

Main Methods:

• Retrospective analysis of 1,083 outpatient colonoscopies performed by 28 endoscopists.
• Extraction of clinical, pre-procedural, and procedural variables from patient charts and reports.
• Assessment of timing variables (morning vs. afternoon, start time, queue position) as surrogates for endoscopist fatigue.

Main Results:

• A trend towards reduced polyp detection in afternoon procedures was observed (12.4% reduction).
• Each hour later in the day was associated with a 4.6% decrease in polyp detection (P=0.005).
• Each increase in queue position correlated with a 5.4% reduction in polyp detection (P=0.016), even after controlling for endoscopist.

Conclusions:

• Polyp detection rates decrease as the day progresses, suggesting endoscopist fatigue impacts performance.
• Queue position emerges as a potential novel surrogate measure for assessing operator fatigue during colonoscopy.
• These findings highlight the need to consider scheduling and fatigue management in endoscopy suites.