Introduction Studies have shown that there are a multitude of factors that affect the quality of colonoscopy. However, the effect of the endoscopist mental workload on their performance has been neglected. It is shown that health professionals exposed to excessive workloads and fatigue show degraded performance. The aim of this study was to measure the effect of mental workload as represented by the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), on colonoscopic performance relative to the experience of the endoscopist and colonoscopy scheduling.
Methods Procedures were observed prospectively in one institution for 3 groups; trainees, consultants and bowel cancer specialist programme (BCSP) endoscopists. On reaching the caecum the endoscopist marked on a validated pro-forma their corresponding workload on six subscales; mental demand, physical demand, temporal demand, effort, frustration and own performance, to generate a NASA-TLX score. Data on performance which included caecal intubation times (CIT), patient comfort and polyp detection rate (PDR) were noted. In addition, withdrawal times, time of day (am or pm) and queue order for procedures were recorded.
Results A total of 202 procedures were undertaken between 6 endoscopists with a mean CIT of 9.2 minutes and PDR of 42%. Increasing mental workload was associated with increasing CIT (r = 0.61, p = 0.07) and inversely associated with withdrawal time (r = 0.72, p = 0.03). The mean mental workload during colonoscopy was lower in BCSP endoscopist v consultants v trainees (188 v 254 v 352 p <0.01). On multivariate analysis, absence of polyp detection was associated with a procedure that was undertaken in pm with an above mean mental workload (OR 1.62, 95% CI 1.38–2.07) and withdrawal time of <5 minutes (OR 1.53, 95% CI 1.32–1.91). Increased patient discomfort was associated with increased frustration on the subscale of the NASA-TLX score (OR 1.59, 95% 1.37–1.93) and being a trainee (OR 1.11, 95% 1.03–1.22). The use of ScopeGuide reduced the mental workload of consultants (227 v 282 p<0.01), but not trainees or experts. Queue position had no impact on any of the markers of performance.
Conclusion This study shows that high mental workload experienced during colonoscopy has a significant detrimental effect on the performance of endoscopists. Drop in PDR in pm procedures when only associated with high mental workload may explain some of the conflicting results of daily variations of PDR in other studies. Further studies are now required to look into measures that may reduce excessive mental workload.
Disclosure of Interest None Declared