Impact of Operator Fatigue on Endoscopy Performance: Implications for Procedure Scheduling
Impact of Operator Fatigue on Endoscopy Performance: Implications for Procedure Scheduling
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DOI：
10.1007/s10620-008-0549-7
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发表时间：
2009-08-01
影响因子：
3.1
通讯作者：
Leong, Wai Ling
中科院分区：
文献类型：
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作者：
Harewood, Gavin C.;Chrysostomou, Kristia;Leong, Wai Ling
背景随着内窥镜手术量的增加，内窥镜医生的工作量不得不增加以满足这种不断增长的需求。本研究的目的是通过比较基于时间顺序的结果来描述内镜医师疲劳对内镜检查质量的影响。方法前瞻性观察连续性内镜手术。根据时间顺序，比较结肠镜检查质量指标（盲肠插管率、病变检出率、撤出时间、插入时间）和食管胃镜检查（EGD）持续时间。结果结肠镜检查完成率随着连续操作而下降;第1至第3次操作的完成率（90%）显著高于第4次和后续操作（76%）（P = 0.03）。中位插入时间延长;第1次至第4次手术的时间[8 min，四分位距（IQR）6-11 min]短于第5次和后续手术（10 min，IQR 7-15 min）（P = 0.06）。病变检出率、停药时间和EGD持续时间随手术顺序保持稳定。结论结肠镜盲肠插管率随着连续操作而下降。插入时间似乎也有延长的趋势。令人放心的是，结肠镜检查的其他质量指标（病变检测和停药时间）和EGD持续时间似乎不受重复程序的影响。
Background With increasing volumes of endoscopic procedures, endoscopists' workload has had to increase to meet this escalating demand. The aim of this study was to characterize the impact of endoscopist fatigue on quality of endoscopy performance by comparing outcomes based on chronological procedure order. Methods Consecutive endoscopic procedures were prospectively observed. Quality indicators of colonoscopy (cecal intubation rate, lesion detection, withdrawal time, insertion time) and esophagogastroduodenoscopy (EGD) duration were compared among procedures based on their chronological sequence. Results Colonoscopy completion rates declined with successive procedures; completion for 1st to 3rd procedures (90%) was significantly higher than for 4th and subsequent procedures (76%) (P = 0.03). Median insertion times lengthened; times for 1st to 4th procedures [8 min, interquartile range (IQR) 6-11 min] were shorter than for 5th and subsequent procedures (10 min, IQR 7-15 min) (P = 0.06). Lesion detection rates, withdrawal times, and EGD duration remained stable with procedure order. Conclusions Colonoscopy cecal intubation rates appear to decline with successive procedures. There also appears to be a trend for insertion times to lengthen. Reassuringly, other quality indicators of colonoscopy (lesion detection and withdrawal time) and EGD duration do not appear to be impacted by repetitive procedures.