Shorter Work Shifts for Doctors Might Aid in Detection of Colon Polyps

http://www.sciencedaily.com/releases/2010/05/100503092028.htm

ScienceDaily (May 3, 2010) — A shorter daily shift schedule for endoscopists, the physicians who perform colonoscopies, avoids a decrease in the polyp detection rate as the day progresses, research from Mayo Clinic indicates.

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"Some people develop colon cancer even after having colonoscopies," says Gregory Munson, M.D., M.P.H., a gastroenterology fellow at Mayo Clinic and study co-author. "Polyp miss rates are partially to blame, so we want to discover how to make the quality of the colonoscopy exam better.

"It's known already that longer colon exam times during endoscope withdrawal increase polyp detection rates. Our data show that each additional minute spent on withdrawal predicts a 4 percent increase in the polyp detection rate. This has led some health care facilities to require a minimum withdrawal time. We were curious whether shorter shifts positively influence polyp detection rates."

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According to Dawn Francis, M.D., M.H.S., a gastroenterologist at Mayo Clinic and lead researcher, these findings differ from similar studies done at other health care facilities that employ traditional half-day shifts. The decrease in polyp detection rates later in the day in those studies is attributed to endoscopist fatigue.

"Our endoscopists usually work only one three-hour shift per day rather than a half or full day of endoscopy," Dr. Francis says. "With shorter shifts throughout the day, we don't see the drop in polyp detection rate later in the day that has previously been reported. Other health care facilities might also want to consider a model that breaks up the day into three-hour shifts."

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"It's hard to tell from the data," Dr. Munson says. "Despite our attempt to control for patient and endoscopist variables, it could be that patients who show up at midday have more polyps or that endoscopists are better at detecting polyps during midday. We need to do more analysis to pinpoint the factors that make a difference."

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