Effect of GI endoscopy nurse experience on screening colonoscopy outcomes

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 I 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 I standard deviation above the mean compared with 12% for more experienced nurses (OR 1.60 [95% Cl, 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. (Gastrointest Endosc 2009;70:331-43.)