title: Patient comfort and quality in colonoscopy.
abstract: OBJECTIVE
  To explore the relationship of patient comfort and experience to commonly used performance indicators for colonoscopy.
  
  
  METHODS
  All colonoscopies performed in our four endoscopy centres are recorded in two reporting systems that log key performance indicators. From 2008 to 2011, all procedures performed by qualified endoscopists were evaluated; procedures performed by trainees were excluded. The following variables were measured: Caecal intubation rate (CIR), nurse-reported comfort levels (NRCL) on a scale from 1 to 5, polyp detection rate (PDR), patient experience of the procedure (worse than expected, as expected, better than expected), and use of sedation and analgesia. Pearson's correlation coefficient was used to identify relationships between performance indicators.
  
  
  RESULTS
  A total of 17027 colonoscopies were performed by 23 independent endoscopists between 2008 and 2011. Caecal intubation rate varied from 79.0% to 97.8%, with 18 out of 23 endoscopists achieving a CIR of > 90%. The percentage of patients experiencing significant discomfort during their procedure (defined as NRCL of 4 or 5) ranged from 3.9% to 19.2% with an average of 7.7%. CIR was negatively correlated with NRCL-45 (r = -0.61, P < 0.005), and with poor patient experience (r = -0.54, P < 0.01). The average dose of midazolam (mean 1.9 mg, with a range of 1.1 to 3.5 mg) given by the endoscopist was negatively correlated with CIR (r = -0.59, P < 0.01). CIR was positively correlated with PDR (r = 0.44, P < 0.05), and with the numbers of procedures performed by the endoscopists (r = 0.64, P < 0.01).
  
  
  CONCLUSIONS
  The best colonoscopists have a higher CIR, use less sedation, cause less discomfort and find more polyps. Measuring patient comfort is valuable in monitoring performance.
authors.affiliation: Department of Gastroenterology, Gloucestershire Hospitals NHS Trust, Gloucester GL1 3NN, United Kingdom. v.ekkelenkamp@erasmusmc.nl
authors.forename: Vivian E
authors.initials: VE
authors.lastname: Ekkelenkamp
authors.forename: Kevin
authors.initials: K
authors.lastname: Dowler
authors.forename: Roland M
authors.initials: RM
authors.lastname: Valori
authors.forename: Paul
authors.initials: P
authors.lastname: Dunckley
mesh_terms: D000698:Analgesia; D002432:Cecum; D002983:Clinical Competence; D003110:Colonic Neoplasms / Q000175:diagnosis; D003111:Colonic Polyps / Q000175:diagnosis; D003113:Colonoscopy / Q000379:methods / Q000592:standards*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D017060:Patient Satisfaction; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D006113:United Kingdom
chemical_list: D008874:Midazolam
keywords: Colonoscopy; Comfort; Endoscopy; Performance; Quality