The Effectiveness of the Sterile Cockpit Technique in Increasing Adenoma Detection Rates

Abstract

Purpose: The adenoma detection rate (ADR) is considered a quality indicator of colonoscopies. Various interventions have shown potential to increase the ADR. The “sterile cockpit technique” (SCT) focuses on minimizing environmental distraction upon withdrawal during screening colonoscopies. The aim of this study is to determine the effect of the SCT on ADR. Methods: Screening colonoscopy data has been collected prospectively over 5 months in a universitybased hospital setting from 14 gastroenterology physicians and 8 gastroenterology fellows. Only outpatient screening colonoscopies were included. We recorded patient demographics, procedural details, environmental details, polyp detection rate, and ADR for 3 months without the SCT intervention and then 2 months with the SCT intervention. Definitions of environmental distraction level (low, med, high) were made prior to commencement of the study and agreed upon by the endoscopist and nurse. The SCT intervention consisted of placing a “quiet” sign on the endoscopy room's door and implementing a policy to keep conversation in the endoscopy room limited to direct patient care during withdrawal. This is an ongoing study. Results: Of the 1,358 patients, there were 798 patients in the pre-intervention group and 560 in the postintervention group. Females comprised 56% and 58% of the pre- and post-intervention groups, respectively. Mean age was 60 and 61 in the pre- and post-intervention groups, respectively. Interval screening colonoscopies represented 54% of pre-intervention colonoscopies and 62% of the post-intervention colonoscopies (p=0.01). Adenoma detection rate during the pre-intervention period was 38%, and 36% during the post-intervention period (p=0.41). Polyp detection rate was 50% in both groups (p=0.93). In the post-intervention period, environments defined as “high” distraction decreased from 13.1% to 6.0% while environments defined as “low” distraction increased from 71.2% to 82.7% (p < 0.0001). Low distraction environments were associated with shorter withdrawal times as compared to high distraction environments (mean 9.8 min vs 12.7 min, p < 0.0001). Conclusion: Environmental distraction levels significantly decreased with the SCT intervention; however, there was no significant change in adenoma detection rates. A significantly greater number of interval screening colonoscopies as compared to first time screening colonoscopies in the post-intervention group may have contributed to these findings. Data collection and analyses are ongoing which may give light to current results.