title: Is production pressure jeopardizing the quality of colonoscopy? A survey of U.S. endoscopists' practices and perceptions.
abstract: 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.
  
  
  METHODS
  We conducted a 40-question online survey to assess endoscopists' practices and perceptions concerning production pressure.
  
  
  METHODS
  A total of 5030 U.S. American Society for Gastrointestinal Endoscopy members.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  Nonresponse bias due to low response rate (22.3%).
  
  
  CONCLUSIONS
  Production pressure influences the conduct of colonoscopy for many endoscopists and could have an adverse effect on the outcome of colorectal cancer screening. (
  
  
  BACKGROUND
  RE:GIE D 11-01288R1.) The study was an Internet study and did not involve human subjects.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Mount Sinai Medical Center, New York City, New York, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Whitson
authors.forename: Carol A
authors.initials: CA
authors.lastname: Bodian
authors.forename: James
authors.initials: J
authors.lastname: Aisenberg
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Cohen
mesh_terms: D001291:Attitude of Health Personnel; D003113:Colonoscopy / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D016526:Workload / Q000706:statistics & numerical data*