Physician-Directed Bolus Sedation for Colonoscopy Improves Endoscopy Unit Efficiency

Abstract

Introduction: To determine the impact of implementation of a physician-directed bolus sedation policy for colonoscopy on endoscopy unit efficiency and patient satisfaction. Methods: We performed a retrospective analysis of time data for colonoscopies performed between April 2010 and April 2011 at a hospital-based endoscopy unit affiliated with an academic health system. Colonoscopies performed prior to October 2010 were performed under a nurse-directed titration sedation policy, in which nurses administered incremental doses of fentanyl and midazolam until sedation was felt to be adequate to begin the procedure. Colonoscopies performed after October 2010 were performed under a physician-directed bolus sedation policy, in which physicians directed the administration of fentanyl and midazolam guided by a weight-based dosing nomogram. To evaluate the impact of sedation policy on endoscopy unit efficiency, we compared the total procedure time, which is the time interval from the administration of sedation to the completion of the colonoscopy between the two sedation groups. We also analyzed several sub intervals, including: sedation time (sedation start to colonoscopy start); colonoscopy time (colonoscopy start to colonoscopy completion); and recovery time (time from procedure completion to patient discharge). We also compared patient satisfaction surveys performed in a subset of patients from each sedation group. Patient satisfaction was rated on a five-point scale with 1 corresponding to the greatest level of satisfaction and 5 being the least. Results: The results of the analysis are provided in the Table. Bolus sedation had a shorter total procedure time (p<0.01) due to a reduction in sedation time (p<0.01). In contrast, colonoscopy time was minimally increased in the bolus sedation group. Bolus sedation did not significantly change the recovery time, and did not impact patient satisfaction. Conclusion: Physician-directed bolus sedation using a weight-based nomogram improves endoscopy unit efficiency by allowing a faster onset to colonoscopy start, reducing the total procedure time; this benefit does not come at the expense of patient satisfaction.Table 1