Pressures to increase volume of colonoscopies adversely impacts how screenings are performed

March 12, 2012

Researchers at Mount Sinai School of Medicine have found that 92 percent of more than 1,000 gastroenterologists responding to a survey believed that pressures to increase the volume of colonoscopies adversely impacted how they performed their procedures, which could potentially affect the quality of colon cancer screening. The findings, based on responses from members of the American Society for Gastrointestinal Endoscopy (ASGE), are published in the March 2012 issue of Gastrointestinal Endoscopy.

"The number of colonoscopies has risen dramatically over the past fifteen years, but it is imperative that an increase in volume not occur at the expense of quality and safety," said Lawrence B. Cohen, MD, lead study author and an Associate Clinical Professor of Gastroenterology at Mount Sinai. "Balancing quantity and quality is an issue that needs to be addressed in order to ensure the continued success of ."

Overall, 92.3 percent of survey respondents indicated that production pressures, such as heightened demand for the procedure, rising overhead or shrinking , resulted in physicians postponing, aborting or reducing the extent of a colonoscopy procedure. For example, 7.2 percent of participants said production pressures made them reduce the time examining the colon wall, 5.3 percent of participants said these pressures made them abort a difficult colonoscopy, and 69 percent said they performed a colonoscopy on a patient with an unfavorable risk/benefit ratio.

Mount Sinai researchers sent a 40-question survey to the 5,739 members of the ASGE working in the United States and received 1,073 completed responses. The survey focused on three key areas: the respondent's demographic and practice characteristics, the operational characteristics of their facilities and their observations of colleagues.

Additional results of the survey include:

  • 13 percent of respondents indicated that they have insufficient time for a pre-procedure assessment, 7.7 percent believed they routinely had inadequate time to complete an examination and 5.5 percent believed that patients were discharged from the unit prematurely;
  • 47.8 percent of respondents had witnessed a colleague alter their usual practice patterns, within the past three years, as a result of production pressure;
  • 42 percent identified one or more sources of inefficiency in their practice, such as an inadequate number of procedure rooms, insufficient staff, or too few beds in the recovery unit;
  • 77.8 percent believed that their weekly workload was excessive; 97 percent believe the medical care that they provide is equivalent to or better than it was three years ago, but 78.5 percent experienced more work-related stress, compared with three years earlier; and 81 percent indicated they are working harder now to preserve their practice income.
"At Mount Sinai, we have worked diligently to implement continuous quality-improvement programs, offer periodic retraining, and allocate enough time per procedure," said Dr. Cohen. "In fact, we perform colonoscopies in half-day blocks, and emphasize the importance of the quality of bowel cleansing. Ultimately, we all need to confront the issue of production pressure and create these kinds of solutions in order to ensure the delivery of effective screenings."

Explore further: Study examines quality of colonoscopy reporting and performance

Related Stories

Study examines quality of colonoscopy reporting and performance

January 23, 2012
Researchers in the Netherlands assessed the quality of colonoscopy reporting in daily clinical practice and evaluated the quality of colonoscopy performance. They found that colonoscopy reporting varied significantly in clinical ...

Polyp miss rates high for colonoscopies done after poor bowel preparation

June 13, 2011
A new study reports that colonoscopies done with suboptimal bowel preparation are associated with relatively high adenoma (precancerous polyp) miss rates, suggesting that suboptimal bowel preparation substantially decreases ...

Mayo Clinic studies how much practice makes perfect when performing colonoscopies

May 9, 2011
A colonoscopy is an invaluable procedure for detecting problems in the colon and rectum. Doctors can often diagnose gastrointestinal issues and even catch the warning signs of colorectal cancer. Perfecting the skills required ...

Recommended for you

CAR-T immunotherapy may help blood cancer patients who don't respond to standard treatments

October 20, 2017
Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis is one of the first centers nationwide to offer a new immunotherapy that targets certain blood cancers. Newly approved ...

Researchers pinpoint causes for spike in breast cancer genetic testing

October 20, 2017
A sharp rise in the number of women seeking BRCA genetic testing to evaluate their risk of developing breast cancer was driven by multiple factors, including celebrity endorsement, according to researchers at the University ...

Study shows how nerves drive prostate cancer

October 19, 2017
In a study in today's issue of Science, researchers at Albert Einstein College of Medicine, part of Montefiore Medicine, report that certain nerves sustain prostate cancer growth by triggering a switch that causes tumor vessels ...

Gene circuit switches on inside cancer cells, triggers immune attack

October 19, 2017
Researchers at MIT have developed a synthetic gene circuit that triggers the body's immune system to attack cancers when it detects signs of the disease.

One to 10 mutations are needed to drive cancer, scientists find

October 19, 2017
For the first time, scientists have provided unbiased estimates of the number of mutations needed for cancers to develop, in a study of more than 7,500 tumours across 29 cancer types. Researchers from the Wellcome Trust Sanger ...

Researchers target undruggable cancers

October 19, 2017
A new approach to targeting key cancer-linked proteins, thought to be 'undruggable," has been discovered through an alliance between industry and academia.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.