ISG Winter Meeting 2015

Third Prize Poster

John Fintan O'Hara
Our Lady of Lourdes Hospital Drogheda

Poster (15W189)

A retrospective analysis of morning and afternoon colonoscopy in a busy endoscopy centre: Does time of day affect quality?


F O’Hara, J Rasool, YC Khiew, B Hall, J Keohane, S Sengupta


Our Lady of Lourdes Hospital Drogheda


Analysis of key performance indicators (KPIs) provides a measure of quality assurance in endoscopy standards. Numerous studies have reported that KPIs tend to vary based on the time of day of endoscopic procedure. For instance, polyp detection rates (PDR) have been shown to decrease throughout the day (1, 2). Caecal intubation rates (CIR) and patient comfort scores have also been shown to diminish in the afternoon.


This study examined the variability of key KPIs namely PDR, CIR, and patient comfort scores in patients undergoing colonoscopy in the morning compared to the afternoon.


Data was extracted from EndoRAAD software (Manitex, Ireland) for OLOL, Drogheda and Louth County Hospital endoscopy units during the period January 2013 and May 2015. Baseline patient data coupled with the aforementioned KPIs was collated and anonymised. All data was encrypted and stored on a protected computer. Morning endoscopies were considered as those occurring prior to 12pm. A comfort score of 3 or more was considered as poorly tolerated. Of note, not all procedures were performed on a full day list and data was analysed both in terms of overall difference and then amongst colonoscopies performed on full day lists. All data expressed as a mean and analysed using SPSS 19 software. A paired T-test was utilised for univariate analysis with p<0.05 considered statistically significant.


In total, 4,541 colonoscopies were included. Of these, 3,568 were performed by endoscopists with a full day list while the remaining 973 were performed on half day lists. Overall, PDR was 25% in the morning compared to 22% in the afternoon (P = 0.413). Interestingly, a comparison of morning and afternoon PDR on full day lists was 25% vs 24% (P=0.980), respectively. Similarly there was no statistically significant difference in either overall CIR (88% vs 84% p=0.416) or comfort scores (76% vs 75%, p=0.158). Again, these parameters did not differ when full day colonoscopy lists were analysed independently; namely CIR (88% vs 90%, p=0.119) and comfort scores (77% vs 73%, p=0.697)


Time of day did not have a statistically significant affect on any of the three KPIs. Furthermore, overall polyp detection rate (25%) and caecal intubation rate (88%) are within current recommended guidelines. Half day and full day colonoscopy lists appear to have equivalent efficacy in our unit and is an effective tool in meeting increasing service demand.