Effect of GI endoscopy nurse experience on screening colonoscopy outcomes

BackgroundThe effect of the GI endoscopy nurse experience on colonoscopy outcomes is unknown.ObjectiveTo determine whether the nurse experience was associated with screening colonoscopy complications, procedure length, and cecal intubation.DesignA retrospective analysis of screening colonoscopies performed by attending physicians between August 2003 and August 2005. Nurse experience was measured in weeks.SettingUniversity of North Carolina Hospitals.SubjectsTwenty-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 MeasurementsThe primary outcome was any immediate complication; secondary outcomes included time to cecum, total procedure time, and cecal intubation rate.ResultsIn 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.LimitationsA retrospective, single-center study.ConclusionsGI 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.