Is production pressure jeopardizing the quality of colonoscopy? A survey of U.S. endoscopists' practices and perceptions

• Published in: Gastrointestinal endoscopy 2012-03, Vol.75 (3), p.641-648.e8
• Main Authors: Whitson, Matthew J., MD, Bodian, Carol A., DrPH, Aisenberg, James, MD, Cohen, Lawrence B., MD
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Biological and medical sciences; Colonoscopy - standards; Colonoscopy - statistics & numerical data; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Practice Patterns, Physicians; Surveys and Questionnaires; Workload - statistics & numerical data
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2011.10.032

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