Document Detail


Is production pressure jeopardizing the quality of colonoscopy? A survey of U.S. endoscopists' practices and perceptions.
MedLine Citation:
PMID:  22341109     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Fatigue is an underestimated cause of underperformance among physicians. There is evidence that fatigue or other byproducts of production pressure may negatively influence the quality of colonoscopy.
OBJECTIVE: To investigate the practices and perceptions of U.S. endoscopists regarding the effect of production pressure on the performance of colonoscopy.
DESIGN: We conducted a 40-question online survey to assess endoscopists' practices and perceptions concerning production pressure.
SETTING: A total of 5030 U.S. American Society for Gastrointestinal Endoscopy members.
MAIN OUTCOME MEASUREMENTS: The proportion of endoscopists responding positively to questions pertaining to the impact of production pressure on colonoscopy practice.
RESULTS: Ninety-two percent of respondents indicated that production pressure influenced one or more aspects of their endoscopic practices. Examples of production pressure included (1) postponing polypectomy for a subsequent session (2.8%), (2) reducing the length of time spent inspecting the colon (7.2%), and (3) proceeding with colonoscopy in a patient with an unfavorable risk/benefit ratio (69.2%). Forty-eight percent of respondents reported witnessing the effects of production pressure on a colleague. Respondents working fee-for-service and those with >10 years since completion of fellowship were more likely to describe their weekly workloads as excessive compared with those who were salaried (81.3% vs 71.3%; P = .01) and <10 years out of training (81% vs 72.7%; P = .01).
LIMITATIONS: Nonresponse bias due to low response rate (22.3%).
CONCLUSION: Production pressure influences the conduct of colonoscopy for many endoscopists and could have an adverse effect on the outcome of colorectal cancer screening. (Clinical trial registration number: RE:GIE D 11-01288R1.) The study was an Internet study and did not involve human subjects.
Authors:
Matthew J Whitson; Carol A Bodian; James Aisenberg; Lawrence B Cohen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  75     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  641-648.e8     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Medicine, Division of Gastroenterology, Mount Sinai Medical Center, New York City, New York, USA.
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