title: Endoscopist fatigue estimates and colonoscopic adenoma detection in a large community-based setting.
abstract: OBJECTIVE
  Endoscopist fatigue may impact colonoscopy quality, but prior studies conflict, and minimal data exist from community-based practices where most colonoscopies are performed.
  
  
  METHODS
  Within a large, community-based integrated healthcare system, we evaluated the associations among 4 measures of endoscopist fatigue and colonoscopic adenoma detection from 2010 to 2013. Fatigue measures included afternoon versus morning colonoscopy and the number of GI procedures performed before a given colonoscopy, including consideration of prior procedure complexity. Analyses were adjusted for potential confounders using multivariate logistic regression.
  
  
  RESULTS
  We identified 126 gastroenterologists who performed 259,064 total GI procedures (median, 6 per day; range, 1-24), including 76,445 screening and surveillance colonoscopies. Compared with morning examinations, colonoscopies in the afternoon were not associated with lower adenoma detection for screening examinations, surveillance examinations, or their combination (OR for combination, .99; 95% CI, .96-1.03). The number of procedures performed before a given colonoscopy, with or without consideration of prior procedure complexity, was also not inversely associated with adenoma detection (OR for adenoma detection for colonoscopies in the fourth quartile of fatigue based on the number of prior procedures performed vs colonoscopies performed as the first procedure of the day, .99; 95% CI, .94-1.04).
  
  
  CONCLUSIONS
  In a large community-based setting, adenoma detection for screening and surveillance colonoscopies were not associated with either time of day or the number of prior procedures performed by the endoscopist, within the range of procedure volumes evaluated. The lack of association persisted after accounting for prior procedure complexity.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lee
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Jensen
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Marks
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
authors.forename: Wei K
authors.initials: WK
authors.lastname: Zhao
authors.affiliation: Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Chyke A
authors.initials: CA
authors.lastname: Doubeni
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors.forename: Ann G
authors.initials: AG
authors.lastname: Zauber
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
authors.forename: Virginia P
authors.initials: VP
authors.lastname: Quinn
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
authors.forename: Theodore R
authors.initials: TR
authors.lastname: Levin
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Corley
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005221:Fatigue; D005260:Female; D000072102:Gastroenterologists; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D016526:Workload