Time of day variation in polyp detection rate for colonoscopies performed on a 3-hour shift schedule
Time of day variation in polyp detection rate for colonoscopies performed on a 3-hour shift schedule
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DOI：
10.1016/j.gie.2010.07.025
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发表时间：
2011-03-01
影响因子：
7.7
通讯作者：
Francis, Dawn L.
中科院分区：
文献类型：
--
作者：
Munson, Gregory W.;Harewood, Gavin C.;Francis, Dawn L.
背景：最近的研究表明，结肠镜息肉检出率（PDR）随时间变化，可能是因为内镜医师疲劳。马约诊所罗切斯特（MCR）计划结肠镜检查3小时轮班，这应该尽量减少fatigue.Objective：检查PDR变化与MCR轮班schedule. Design：回顾性队列。程序被排除在缺乏退出时间戳，适应症以外的平均风险筛选，肠道准备不足，同伴参与，或性能的内镜医师与低数量的endoscopies performed.Intervention：无。主要结果测量：PDR（结肠镜检查与>= 1息肉除以结肠镜检查总数）的转变day.Results：我们分析了3846结肠镜检查。在单变量分析中，PDR随偏移而显著变化（P = .008）;偏移1和偏移3的结果相似（分别为39.0%和38.7%），而偏移2的PDR最高（44.7%）。平均停药时间稳定（P = .92）。在单变量分析中，PDR在一年中的不同月份也有显著差异（P <0.0001）。在多变量分析中，患者年龄（P < .0001），患者性别（P <0.0001），内镜医师平均停药时间（P < .0001），月份（P = 0.0002），内镜医师经验（P = 0.04），以及粘粒移位（P = .048）显著预测PDR。局限性：回顾性研究。结论：MCR的3小时轮班时间表并没有显示PDR随着粘土的进展而减少，正如最近的其他研究所示。其他机构的干预试验可以确定轮班时间的改变是否会导致PDR的改善。（Gastrointest Endosc 2011;73：467-75.）
Background: Recent research suggests that the colonoscopy polyp detection rate (PDR) varies by time of day, possibly because of endoscopist fatigue. Mayo Clinic Rochester (MCR) schedules colonoscopies on 3-hour shifts, which should minimize fatigue.Objective: To examine PDR variation with the MCR shift schedule.Design: Retrospective cohort.Setting: Outpatient tertiary-care center.Patients: This study involved completed outpatient colonoscopies in 2008. Procedures were excluded for lack of withdrawal time stamps, indications other than average-risk screening, inadequate bowel preparation, fellow participation, or performance by endoscopists with a low number of endoscopies performed.Intervention: None.Main Outcome Measurements: PDR (colonoscopies with >= 1 polyp divided by total number of colonoscopies) by shift of day.Results: We analyzed 3846 colonoscopies. PDR varied significantly by shift (P = .008) on univariate analysis; results for shifts 1 and 3 were similar (39.0% vs 38.7%, respectively) whereas shift 2 had the highest PDR (44.7%). Mean withdrawal times were stable (P = .92). PDR also varied significantly (P < .0001) by month of year on univariate analysis. On multivariate analysis, patient age (P < .0001), patient gender (P < .0001), endoscopist mean withdrawal time (P < .0001), month of year (P = .0002), endoscopist experience (P = .04), and shift of clay (P = .048) significantly predicted PDR.Limitations: Retrospective study.Conclusion: MCR's 3-hour shift schedule does not show a decrease in PDR as the clay progresses, as seen in other recent studies. Intervention trials at other institutions could determine whether alterations in shift length lead to PDR improvements. (Gastrointest Endosc 2011;73:467-75.)