Effect of GI endoscopy nurse experience on screening colonoscopy outcomes

Abstract

Background: The effect of the GI endoscopy nurse experience on colonoscopy outcomes is unknown.

Objective: To determine whether the nurse experience was associated with screening colonoscopy complications, procedure length, and cecal intubation.

Design: A retrospective analysis of screening colonoscopies performed by attending physicians between August 2003 and August 2005. Nurse experience was measured in weeks.

Setting: University of North Carolina Hospitals.

Subjects: Twenty-nine nurses were employed during the study period, 19 of whom were newly hired. A total of 3631 eligible screening colonoscopies were analyzed.

Main outcome measurements: The primary outcome was any immediate complication; secondary outcomes included time to cecum, total procedure time, and cecal intubation rate.

Results: In procedures staffed by nurses with 2 weeks of experience or less, 3.2% had complications compared with 0.3% for procedures with more experienced nurses (odds ratio [OR] 10.4 [95% CI, 3.55-30.2]). For nurses with 6 months or less of experience, 18% of procedures had cecal-intubation times more than 1 standard deviation above the mean compared with 12% for more experienced nurses (OR 1.60 [95% CI, 1.30-1.97]). Similar results were seen for the total procedure duration (OR 1.61 [95% CI, 1.32-1.97]) and cecal-intubation rates (OR 1.81 [95% CI, 1.37-2.39]). All relationships held after adjusting for potential confounding factors.

Limitations: A retrospective, single-center study.

Conclusions: GI endoscopy nurse inexperience is associated with an increase in immediate complications, prolonged procedure times, and decreased cecal-intubation rates for screening colonoscopies. These findings have implications for nurse training, procedure efficiency, colonoscopy quality assessment, and patient safety.

Figure 1

Association between amount of GI endoscopy nursing experience and immediate complications from screening colonoscopy. Note that both absolute numbers and proportions are presented on this figure, as specified on the y-axis. The black bars represent the total number of complications occurring at each level of nursing experience. The grey bars represent the proportion of cases in which complications occurred for each level of nursing experience. The dotted line shows that for the primary outcome of complications, nurse experience was dichotomized at two weeks of experience or less. By chi-square, p < 0.001 for the overall association comparing greater and less than two weeks of experience.