Is production pressure jeopardizing the quality of colonoscopy? A survey of U.S. endoscopists' practices and perceptions

Gastrointest Endosc. 2012 Mar;75(3):641-8. doi: 10.1016/j.gie.2011.10.032.


Background: Fatigue is an underestimated cause of underperformance among physicians. There is evidence that fatigue or other byproducts of production pressure may negatively influence the quality of colonoscopy.

Objective: To investigate the practices and perceptions of U.S. endoscopists regarding the effect of production pressure on the performance of colonoscopy.

Design: We conducted a 40-question online survey to assess endoscopists' practices and perceptions concerning production pressure.

Setting: A total of 5030 U.S. American Society for Gastrointestinal Endoscopy members.

Main outcome measurements: The proportion of endoscopists responding positively to questions pertaining to the impact of production pressure on colonoscopy practice.

Results: Ninety-two percent of respondents indicated that production pressure influenced one or more aspects of their endoscopic practices. Examples of production pressure included (1) postponing polypectomy for a subsequent session (2.8%), (2) reducing the length of time spent inspecting the colon (7.2%), and (3) proceeding with colonoscopy in a patient with an unfavorable risk/benefit ratio (69.2%). Forty-eight percent of respondents reported witnessing the effects of production pressure on a colleague. Respondents working fee-for-service and those with >10 years since completion of fellowship were more likely to describe their weekly workloads as excessive compared with those who were salaried (81.3% vs 71.3%; P = .01) and <10 years out of training (81% vs 72.7%; P = .01).

Limitations: Nonresponse bias due to low response rate (22.3%).

Conclusion: Production pressure influences the conduct of colonoscopy for many endoscopists and could have an adverse effect on the outcome of colorectal cancer screening. (

Clinical trial registration number: RE:GIE D 11-01288R1.) The study was an Internet study and did not involve human subjects.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel*
  • Colonoscopy / standards*
  • Colonoscopy / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Practice Patterns, Physicians'*
  • Surveys and Questionnaires
  • Workload / statistics & numerical data*