What is Zero Harm Endoscopy?

It may come as a surprise, but the hospital is actually one of the most dangerous places to work in America. In 2019, U.S. hospitals recorded over 220,000 work-related injuries and illnesses—a rate that’s nearly twice the rate for private industry as a whole. 

The types of injuries and illnesses sustained by health workers can vary depending on the speciality and setting, but one type of injury is a common thread seen across all healthcare settings. Musculoskeletal disorders (MSDs) are the result of a person's repeated exposure to daily activities that cause them pain or discomfort over time. They include injuries or disorders effecting the muscles, nerves, tendons, joints, cartilage, and spinal discs, and commonly result in sprains, strains, and more severe injuries as a result of repeated overexertion. Recent data suggests that MSDs are a particularly common cause of injury to procedure-performing health workers, especially nurses and technicians. Nurses sustain MSD-related injuries largely due to the labor intensive nature of their jobs; patient repositioning activities (like moving a patient from the toilet to a chair or lifting a patient out of bed) require heavy lifting and holding awkward, uncomfortable postures for long periods of time which can lead to injury. 

In response to the growing crisis of healthcare work-related injuries, many healthcare systems have begun to move toward a goal of zero harm. Historically, zero harm practices focused almost entirely on the patient, and were defined as the effort to reduce any and all preventable harm to patients before, during, and after medical care. More recently that definition of zero harm has been expanded to include healthcare professionals as well. When a health worker is injured on the job it affects the quality of care, which naturally creates more roadblocks to achieving a zero harm standard. 

MSDs are a concern in all medical specialties, but they present a unique threat to endoscopy professionals. Among physicians, 89% of endoscopists report musculoskeletal injuries compared to 37% of physicians in other specialities.  Endoscopy is a nonsurgical, exploratory procedure that involves the insertion of a small camera at the end of a long, thin tube into the body to carry out observation, imaging, and minor procedures among other tasks. Colonoscopy—a type of endoscopic procedure that examines the lower digestive tract including the large intestine (colon) and the rectum—is considered to be the gold standard of colorectal cancer detection. The U.S. Preventive Services Task Force recommends that all people aged 45 to 75 undergo colorectal cancer screening, which likely is why colonoscopies constitute nearly 68% (17 million) of the 28 million gastrointestinal endoscopies performed each year in the United States as of 2019. The rate of procedures like endoscopy and colonoscopy are projected to grow significantly largely in part to an aging population, the general trend toward diagnosing and treating GI-related conditions, particularly colorectal cancer, and waning social stigma around undergoing colonoscopies. 

With this in mind, endoscopy is an area of healthcare that each of us will likely encounter as either a healthcare worker or as a patient. Zero harm endoscopy and the steps we can take to achieve such a standard is a necessary conversation worth having. If a procedure is risky for health workers, it cannot be safe for patients. Health workers simply cannot fulfill their duties and provide high-quality and safe care to patients when they are exposed to repeated risk of harm. 

Reducing harm in the healthcare workforce is no easy task; however, there are clear measures we can take to move us one step closer to a universal culture of patient and practitioner safety. One such approach is to focus on a model of high reliability—a model of care that maintains consistently, extraordinarily high levels of care and safety with no or extremely few adverse events, despite operating in hazardous conditions. The implementation of zero harm work systems that promote Safe Patient Handling and Mobility (SPHM) is another method of reducing the risk of injury to both the patient and healthcare professional. 

Endoscopy and, more specifically, colonoscopy present a particular challenge in reaching the zero harm standard because the procedures have more associated risk than you might think.

ColoWrap is on a mission to build Zero Harm Endoscopy units that protect patients, personnel, and physicians and improve the overall quality of care during colonoscopy. 

What Makes Endoscopy Risky:

Endoscopy nursing is consistently ranked among the riskiest nursing specialties in terms of frequency and likelihood of MSD injury. Recent studies involving over 600 endoscopy nurses showed that more than half of surveyed nurses had suffered at least one MSD injury, and nearly a fourth had to miss work to recover from those injuries. 

So what exactly is it about endoscopy that makes it especially risky for personnel, especially endoscopy nurses and endoscopy technicians? 

To put it simply, colonoscopy is challenging because the colon moves throughout the procedure, which can give rise to complications and poor patient outcomes. The colon’s constant motion and anatomical variability can cause the endoscopy scope to “catch” in a phenomenon called looping. Looping occurs in up to 90% of colonoscopies and is the primary cause of patient pain, complications, and failed procedures. Looping occurs when the endoscopist pushes the scope forward into the colon but loses one-to-one feedback, halting forward progression towards the cecum. Instead of advancing normally, the scope stretches and distends the colon outward into the patient’s abdomen. 

The most common technique to address looping during colonoscopy is to apply manual abdominal pressure and/or reposition the patient to “splint the colon,” which is where the risk comes into play. Since the colonoscopist has to try to address loop formation and mitigation through scoping techniques, endoscopy nurses and technicians are almost universally left to apply the heavy pressure to the abdomen or to rotate the patient further on their side, or various other positions in an attempt to progress the scope. The significant frequency of looping means that endoscopy nurses and technicians are routinely required to perform these high risk activities that can result in substantial harm. The Bureau of Labor Statistics reports that nursing assistants suffer more debilitating back injuries at work than any other single occupation, including warehouse and construction workers. 

What Zero Harm Endoscopy Means for Endoscopy Personnel:

Established safe patient handling limits indicate that the safe level of push force is 33 pounds for males and 22 pounds for females, for no more than five minutes per day. To combat looping and other complications, endoscopy personnel regularly apply 50 to 115 pounds of push force for ten minutes more per case. In order for endoscopy to ever be truly zero harm, the dilemma of splinting the colon in a way that is both safe for the patient and less physically demanding for the personnel must be established. Offering a less labor-intensive alternative to manually splinting the colon protects endoscopy personnel from injuries related to repeated overexertion and prevents health worker fatigue and exhaustion. 

ColoWrap is a medical device that does the heavy lifting for GI personnel, cultivating a more ergonomically friendly endoscopy environment on the path to zero harm.

ColoWrap is the first device specifically designed to mitigate looping, which: 

• minimizes the need for manual pressure and repositioning, 
• reduces procedure times, 
• and prevents staff injuries and fatigue. 

What Zero Harm Endoscopy Means for Physicians:

In order to address looping, physicians regularly have to torque (twist with substantial force) the endoscope in order to continue the procedure. Repeated torquing can breed devastating injuries over the lifespan of an endoscopist's career—looping has been linked to high numbers of hand, wrist, shoulder, and back injuries in practitioners. A recent study showed 29% of endoscopists reported neck and/or upper back injuries. 

Furthermore, the study showed that among injured endoscopists, only 55% modified their practice techniques to prevent further injury. Improved endoscopy ergonomics is essential to reaching a zero harm goal. Endoscopy will continue to present substantial risk to its practitioners unless steps are taken to adjust procedure techniques and decrease the risk of injury, which ColoWrap can greatly assist with by preventing looping from occurring in the first place.

Studies show that when used correctly, ColoWrap:

• Speeds up cecal intubation time,
• Reduces overall procedure time,
• Promotes better colonoscopy ergonomics, and 
• Improves ADR (adenoma detection rate). 

What Zero Harm Endoscopy Means for Patients: 

Even when done by experienced staff with significant physical strength, applying manual pressure to the patient’s abdomen can still be ineffective and cause patient discomfort or complications. 

ColoWrap was designed with the patient in mind and offers: Shorter, more comfortable procedures that require lighter sedation or providing extra comfort in procedures with no sedation at all:

• Better outcomes reducing the likelihood of a post-colonoscopy ER visit, 
• Improved procedures for overweight and obese patients, and
• Fewer side effects and complications by reducing manual abdominal pressure.

How to Achieve Zero Harm in Endoscopy: 

Over 30 years of research tells us that relying on proper manual abdominal pressure and repositioning techniques alone is not enough to reduce back and musculoskeletal injuries and to create a zero harm endoscopy environment. By promoting improved ergonomics through the use of devices like ColoWrap, we can lighten the load—literally—on endoscopy personnel, providers, and patients. 

Zero harm endoscopy is not an unreachable standard. It’s a goal that we can and need to be taking meaningful steps towards. Health worker safety is patient safety, one cannot exist without the other. The first step to reduce the risk of injury in endoscopy is to reduce the leading problem—looping. ColoWrap has successfully developed the only available solution to reduce the need for staff-applied and injury-inducing manual pressure and patient repositioning during colonoscopy.

Want to learn more about ColoWrap or request pilot information? Drop us a line here.