UW Health Changes Colonscopy Scheduling Based on New Findings
Madison, Wisconsin - Surprising results from its own study have prompted leaders at the UW Health Digestive Health Center to change the way physicians are scheduled to perform colonoscopies.
While UW Health’s detection rates for pre-cancerous polyps are well above the national averages, a new study by Dr. Mark Benson, assistant professor of medicine, has found that doctors who did colonoscopies after being on call the night before had a 24 percent lower rate of detecting adenomas, the precursor to colon cancer.
Benson’s study was published in the American Journal of Gastroenterology earlier this month.
“We have a unique opportunity to be the leaders in this field and make changes that are best for the patients. Our focus is on patient-centered care, and as leaders in procedure quality and outcome, we are discussing solutions,” said Benson.
The study, “Influence of Previous Night Call and Sleep Deprivation on Screening Colonoscopy Quality” found that performing procedures after being on call at night led to a 24% decrease in adenoma detection rates. Adenomas are non-cancerous polyps and need to be removed to prevent colon cancer.
According to the American Society for Gastrointestinal Endoscopy, the US guidelines state providers should find pre-cancerous polyps in approximately 20 percent of average-risk patients who are 50 years or older and who undergo colonoscopy screenings. According to Benson’s research, UW Health physicians find pre-cancerous polyps in approximately 40 percent of patients screened.
“As a group, we are well above the minimal accepted baseline. My recent study found that we are finding fewer polyps following a night of call in which we were called in to do emergent procedures and thus we were sleep-deprived,” said Benson.
The study found those doctors coming off emergency procedures found polyps in only 30 percent of patients. That is still above the minimal standard, but according to Dr. Michael Lucey, head of the division of gastroenterology, changes need to be made.
“Our response to these findings has been to remove doctors from the endoscopy schedule after a night of call in which they have undertaken emergency procedures. We also are planning further studies to better understand the impact of interrupted sleep on the capacity of gastroenterologists to undertake complex tasks such as a colonoscopy,” said Lucey.
The study suggests that interrupted sleep hampers the doctor from achieving the highest quality of screening colonoscopy. It’s long been established that lack of sleep decreases both cognitive and motor skills function, but Benson saw there were very few studies done to evaluate the influence of sleep deprivation on endoscopic outcomes.
“If you are on call the night before, and you perform colonoscopies the next afternoon, you might miss something. We need to change cover schedule techniques. When I first proposed this study I had complete support from my entire department. My wife suggested I study this after I was talking about how tired I was after a night of call,” said Benson.
The study was performed on average-risk patients undergoing routine colonoscopy screenings between July 1, 2010 and March 31, 2012. The procedures were completed by 12 attending academic gastroenterologists. A total of 447 colonoscopies were performed by gastroenterologists who were on call the night before. There was a significant 24% relative decrease in the detection rates in procedures performed by sleep-deprived attending gastroenterologists.
Benson believes that the likely impact of attending physicians’ sleep deprivation on a clinical outcome needs to be more widely recognized. There are no required restrictions on the hours of clinical work completed by the attending physicians in practice. According to Benson’s study, that leads to an unacceptable potential risk during a common screening procedure.
“We don’t want to put anything back on the patient; as medical professionals we need to find a way to make the change and give the best care possible. That is what we are doing moving forward. The patient always comes first,” said Benson.
Date Published: 07/30/2014