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

(Press-News.org) 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 colon cancer prevention programs."

Overall, 92.3 percent of survey respondents indicated that production pressures, such as heightened demand for the procedure, rising overhead or shrinking reimbursement rates, 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 colonoscopy screenings."

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Mount Sinai's Gastroenterology Division is ranked fifth in the country among top hospitals, according to U.S. News and World Report.

About The Mount Sinai Medical Center

The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Mount Sinai School of Medicine. Established in 1968, Mount Sinai School of Medicine is one of the leading medical schools in the United States. The Medical School is noted for innovation in education, biomedical research, clinical care delivery, and local and global community service. It has more than 3,400 faculty in 32 departments and 14 research institutes, and ranks among the top 20 medical schools both in National Institutes of Health (NIH) funding and by US News and World Report.

The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation's oldest, largest and most-respected voluntary hospitals. In 2011, US News and World Report ranked The Mount Sinai Hospital 16th on its elite Honor Roll of the nation's top hospitals based on reputation, safety, and other patient-care factors. Of the top 20 hospitals in the United States, Mount Sinai is one of 12 integrated academic medical centers whose medical school ranks among the top 20 in NIH funding and US News and World Report and whose hospital is on the US News and World Report Honor Roll. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 560,000 outpatient visits took place.

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