Feeling the Pressure: Uncovering the Hidden Risks of Colonoscopies

First Case Intro: From the studios of Healthcare HQ. You're listening to First Case.

Melanie Perry: Joining us now is Connie Hall, Endoscopy Supervisor at the University of Missouri in Columbia, Missouri. And Connie, thank you so much for being here today.

Connie Hall: You're welcome. Thanks for having me.

Melanie Perry: You know, Connie. It is wonderful to have you here today and to cover this topic because we don't go as often as we should into the world of endoscopy and colonoscopies.

And this is really a topic that we should be talking about more because so many operating room professionals find themselves working in endo more than they realize, and we aren't as educated as we should be. So I'm excited to have you here today and you have been doing this for a very long time and have a lot of experience and have seen so many things.

So why don't you just first start us off with introducing yourself to our audience and tell them a little bit about who you are.

Connie Hall: So, yeah, I'm Connie. I'm a certified GI nurse, certified endoscopic reprocessor. I've been involved with GI for 40 years, give or take a few, full time probably for the last 30 almost 35 years. I really feel certified nurses are important to our specialty and so obtained that certification 30 years ago, probably. I think an ongoing education is very important for our GI nurses. But you know, colonoscopy is probably the single most important thing every individual on the planet earth can do for themselves.

It's the most dreaded procedure probably that we, we do in, in healthcare. But in many ways, it's the most important procedure that we could do we can do for anyone. So many times patients put it off, put it off, put it off. And then by the time they get to us, you know, bad things have happened. And it's, I think if you don't learn anything else about colonoscopy today, you need to know that early detection is the key. Colon cancer, honestly, second leading cause of cancer in the U. S., completely preventable in 99 percent of the procedures that are cases out there. Early detection. We know the screening age has come down from 50 to 45. I honestly think it should be even less, probably 40. We are just finding colon cancers in younger and younger people. We could talk for a week about why.

Melanie Perry: Well, I'm curious. Why don't we, do you know any of the reasons why we're finding it in younger people?

Connie Hall: Well, I, you know, I think that if we had to sum it up in one word, it's diet. In two words, environment. I mean, we eat crap. Yeah, you're right. I mean, each and every one of us.

We just, all of the, you know, a natural diet is just, a thing of the past. There's so many, you know, the processed foods that we consume and we're all guilty. I mean, I try to avoid it and then, you know, there's that bag of chips that looks so good. So, yeah.

Melanie Perry: And they're delicious when you're hungry, right?

Connie Hall: Yeah, yeah.

I mean, and a lot of this stuff, they put crack in it now, so you can't stop when you start on it. But yeah, the, the processed foods and, and things that are in our environment that we don't even know that we're eating and breathing and consuming. It's funny to me that when early on in my career, we found colon cancers in old people.

You know, we'd find these colon cancers in these 70, 80 year olds. It was a, it was unfortunate, but it was like, well, you know, they're, they're really old. And, and, and nowadays it's, We're finding them in 30, 35, 40 year olds. That's pretty sad.

Melanie Perry: Yeah, that is sad.

Connie Hall: So it's sobering. I think to think that what used to be, you know, something that we saw only in our elderly population has just slowly digressed instead of progressed, slowly gone down.

Melanie Perry: It's going the wrong direction. Yeah. Going the wrong direction to our younger, our younger and younger patients. And, you know, diet, exercise, environment, all of those things do play a role. And colonoscopy screenings too, I think, and the way colonoscopies are done has changed throughout your career and the whole colonoscopy, probably procedure in 35 years, 40 years of doing this, that has changed.

Can you talk about the progression and the change that you've seen since you, since you started?

Connie Hall: Yeah, I think the probably, there's two things that stand out to me, the preps with our preps have improved. Preps are never going to be good. No, there's just no way it's going to be fun to do about prep.

Melanie Perry: Nope!

Connie Hall: Um, but there are much better ways to prep much more palatable or tolerable drinks, I guess is the best way to say it. And then, the other thing that has dramatically changed is the sedation. You know, we did conscious sedation. Well, I was just telling somebody yesterday that when I first started doing this, we would mainline 10 milligrams of Valium.

If that worked, great. If it didn't work, well, sorry for you, but you don't get any more, and that's all we, because it was before Versed was invented. It was before Fentanyl was invented. I mean, you know, I'm old.

Melanie Perry: That's what we had, right? Yes. Yeah.

Connie Hall: It's, it's what we did. The doctor gave it, and, sometimes it worked great, and sometimes we had to sit on them.

You know, it just, it's so, I mean, to, to go from that, to watching MAC, to anesthesia, give a MAC sedation to a patient is, is night and day. There's still conscious sedation being done out there, and, and I think that we can do a really good job on patients with conscious sedation, but it's not, exactly the norm at this stage in the game, but you know, there's anesthesia shortages and there's just not always enough providers for that, you know, but then as you evolve into the exam itself, you know, when you gave conscious sedation and you needed a patient to move, they could, they, you know, they were slow, but they would turn themselves on their side or onto their back.

And I know we're not really into that yet, but that's also a big change then with the given MAC sedation is you can't. They can't move, you know, they can't, not only can they not move, they can't protect themselves. So...

Melanie Perry: That does play into our conversation.

Connie Hall: It certainly does.

Melanie Perry: Absolutely. And I think that's critical to talk about how anesthesia has changed. And while we have made it better for the patient, for the procedure anesthesia wise, you know, and they can, they, they don't remember it. They just go home. Yeah, you got to get through the bowel prep, but, but then you don't really remember anything. You go home and that's fine. But because of the benefits to improved anesthesia care, now we do have, like you mentioned, other issues where the patient can't respond if they're in pain or they can't, you know, tell us things. And so that does play into an awareness that we need to have for sure.

Before we move on into some of those risks and some of the things we see when colonoscopies aren't just in and out and smooth and done, what about the scopes? Have scopes changed since you started this, since you started doing colonoscopies?

Connie Hall: Yes, they have changed dramatically, so much so that when I first started doing them, there was no video. I mean, they were what we called an OES scope, and so the physician was looking through the eyepiece.

Melanie Perry: Really?

Connie Hall: And they could see what they were doing, but without a teaching head, if you were in the room, You could see nothing.

Melanie Perry: Um, oh my gosh, I didn't know that.

Connie Hall: Yeah. I've had actually had, when I've trained techs in the past in teaching them how to do a polypectomy, they would say, how can you, you're not even looking. How do you know? Well, we had to, when I learned we had to, to feel the snare, we had to know when the snare was tight and feel, when we were cutting, because you couldn't see anything.

You were blind. So, you know, you had to, to be able to do that by the by feeling and knowing how the tension on the wire felt. So anyway, things, a lot of things have changed.

Melanie Perry: Yeah, they have. But then that also adds to that. This is a fantastic screening tool. It is the gold standard for catching colon cancers early.

And we do have all of the video equipment now, and we have the ability to see. And when I've worked in. I, at my facility, I, I get scheduled to work in endo, you know, several times out of the month. And I, you know, I'm amazed as the camera is moving around and the, the surgeons pushing the scope through, he'll stop and be like, Oh, there's a polyp.

I'm like, I didn't see anything, you know? And so like, just what they can see, even the smallest things and that they come up on those cameras. We've got some, we've got really good equipment to be able to see what we're looking for. Yeah.

Connie Hall: Oh, the image is unreal compared to the old days cause even with those OES scopes, there was like a pie shape piece missing in the image because of the way the cabling and the computer chip and stuff worked, but also not just the image, but the the way the scopes are designed. You know, there was only one size of scope. It was only an adult scope now We have PCF scopes which are pediatric scopes The diameter is a little smaller, but also the flexibility of the scopes the old scopes were very stiff if physicians retroflexed not only in the rectum, but lots of physicians were trying to retroflex in the cecum.

The cecum is the thinnest mucosa in the colon and you could perforate a colon pretty easily with those stiffer scopes. I still don't recommend retroflexing in the cecum just because I think it's not the greatest idea in the world. But at least with those more flexible scopes, the risk is much less. So, and then also they have what's a stiffener in the scope, which was. There was a time when we would put a really stiff wire through the scope if we couldn't get through and get an exam completed to make the scope stiffer to move through the intestine.

Now you can just turn a little dial and stiffen the scope if you're having trouble in a certain area. So yeah, the advances are just enormous over the last few decades with with our equipment.

Melanie Perry: Yeah. And now, and also the bowel preps. Nobody, I mean, I'm sure people still do, but your only choice isn't to go home and drink a gallon of Golytely anymore. So that is, there are improvements there too.

Connie Hall: Yeah. I mean, you know, the Miralax prep and I, you know, I don't work for Miralax, but it works really well. And it's just simply drinking whatever you want to flavor water with. You know, that's an advance over Golytely, which is still used everywhere you look.

Melanie Perry: Yes. I remember one day I was, when I worked in pain management, the surgeon that I worked with had the, he had turned 50 and he was going to go get his colonoscopy. And he showed up to work that morning with his gallon of Golytely that he was going to start drinking that afternoon. And I'm like, you are a brave man, but you know, he started it that afternoon, but I remember seeing him with his jug and he had his gallon of Golytely, but thankfully there are other options out there too.

But moving forward, you know. The procedure itself has advanced, it's improved over the years, but one thing that we have struggled with since we've been doing these is visibility and whether or not we can actually get the scope through the colon to the cecum so that we can see everything and sometimes it's easy, but sometimes it's not.

How come sometimes colonoscopies are difficult?

Connie Hall: Well, I mean, I think there's a lot of answers to that question. You know, the patients are not all built the same, in a nutshell. Some of it is our population, the, the size of our people, the obesity rate is, you know, highest as we've ever seen. And it's just no secret that morbidly obese people patients are hard to scope, but on the flip side of that, very, very tiny people are also hard to scope, you know.

Melanie Perry: That surprised me.

Connie Hall: Yeah, a 90-year-old, 70-year-old female is a nightmare by no fault of their own, just as the obese patients in general often is no fault of their own. The colon is a very floppy organ for lack of a better term. It is not fixed in one place and It's like trying to thread spaghetti through a straw in.

Melanie Perry: That is a really good description. Wow.

Connie Hall: And sometimes that works like a charm and sometimes it won't work worth a damn. So you just have to. And then also the skill of the endoscopist is a huge part of it. They are not all created equal. Some of them are what I refer to as snake charmers and they can put a scope anywhere. And some of them didn't play enough video games as a child because they can't, their eye hand coordination is simply not there.

Melanie Perry: Go home and play some Minecraft.

Connie Hall: Yeah, exactly.

Melanie Perry: But how often do you think would you say that you have a colonoscopy that is difficult? Is this something that you're talking about seeing once a shift, once a week? How often are they challenging?

Connie Hall: Well, I think that, I don't think there's a day goes by in any lab that you don't have a difficult colon. I mean, you know all of that's, it's a hard answer because it's based on you know, inpatients, outpatients, your volume, but I think everybody anywhere in any department is going to say we've had difficult colons today.

We had a bunch of them today. It's very common. I would say 30 percent of your exams are going to be a challenge. Oftentimes they're not. But about a third of the time you're going to, maybe just in the sigmoid colon, it's not like the entire colon is difficult. The sigmoid colon is usually the hardest area to get through, to advance the scope through on the way to the cecum.

Melanie Perry: So then when it's difficult, what is it that we're doing in order to be able to pass that scope?

Connie Hall: Well, you know, back in the old days before conscious sedation, our first, our first thing would be to turn the patient if they were on their side, we'd turn them on their back. We have gotten away from wanting to do that with the MAC sedation because it's really not easy.

And again, you can get into the whole safety thing of patients not being able to protect their neck, their limbs against the rails. So the first thing we're going to go to is applying abdominal pressure to splint the bowel to allow better manipulation of the, of the scope through the intestine.

Melanie Perry: So that pressure, because the staff, usually it's the, it's the nurse in the room, right? The circulator or the staff nurse gets asked to apply this abdominal pressure. They're putting pressure on the abdomen so that there is something to maybe stabilize the colon so that the camera can pass through. Is that correct? Or the scope can pass through?

Connie Hall: Yeah. I, I, you stabilize is a word. I mean, I always, I tend to use the word splint because we want to allow some resistance.

We want to push against that intestine. So there's resistance that the scope has is not... I'm using my hands because that's how I talk. Um, you know, when the scope pushes on the intestine without anything, it's just going to keep moving the intestine, but if we can feel where the scope is and apply some pressure there, then it allows it to get past that kink, if you will, and continue to advance into the colon.

Melanie Perry: So let's talk about that pressure then. The nurse is applying pressure. What is, look, I mean, how about we start with the patient, okay, because I'm pushing on this patient to splint their colon so the scope can go through. What am I doing to the patient when I, when I do that?

Connie Hall: Well, I think, you know, applying pressure just sounds like such a generic thing to do and anybody should know what they're doing.

And that is not the case. I mean, it is not that generic and it is, there are, precautions that you should take as the person doing that. Could be your techs could be in the room. A lot of places have techs work in the rooms or nursing staff, but you need to be aware of landmarks in the colon of, or in the abdomen of those patients.

You need to be aware of patient history. You need to know if the patient has... You know, patients have all kinds of unusual things that we didn't used to see years ago. They can have pain pumps implanted in their abdomen. They can have the device to read where they scan their glucose, their blood sugar all the time.

Those little things can, they're not just on arms. You see them on abdomens. I mean, on and on it goes. You don't want to go down everybody's medical history. You need to be aware of your patient. You need to look at that abdomen before you start applying pressure. That's how I always teach my staff. Whip that gown up and take a peek.

Cause you don't know what's under there. You can't just assume that every abdomen is just, you know, benign and there's no things that you could be pressing on that you shouldn't be pressing on. The thing I like to really educate people is about spleens. You need to know if they have a history of an enlarged spleen have splenomegaly. If you've ever had a patient return because you ruptured their spleen applying pressure during a colonoscopy to the ER that evening, it's a very memorable day.

Melanie Perry: Has that happened to you?

Connie Hall: I have seen that happen in my departments a handful of times.

Melanie Perry: Really? Yeah. So what is that? I really don't even know how to ask it, but what happens to the patient in that scenario?

Connie Hall: Well, they get uncomfortable. They have pain. They usually come back because of pain.

If you rupture a spleen, the spleen is going to enlarge as blood as it bleeds. And that hurts. And so they come back. They don't know they came back because their spleen is ruptured. They know they came back because they had a colonoscopy and they are uncomfortable. If you're an ER nurse. Ask that question when you see your patients because ask if you've had any procedures in the last 24 hours because that is a one, a nursing assessment that's not taught, but every good nurse should think of that when they're seeing a patient.

We've had patients that have post op phone calls said, why does my stomach hurt? Why do I have bruises on my stomach? You know, you can go into a whole lecture on how many pounds of pressure you're applying, but just because the doctor says push harder, I don't believe that's the right answer because you can injure a patient pushing harder.

Melanie Perry: Absolutely. And thinking of, of the extent of the damage that you can do if you're just blindly applying pressure and it's, it's significant and it's not just the patient who is at risk when you're applying pressure, but staff members can be at risk too. What, what is the staff member at risk for when they're standing there applying that pressure?

Connie Hall: Well, in a nutshell, musculoskeletal problems. But, you know, personally, myself, I have had my wrist hurt, my shoulders hurt, my back hurt. And basically in that order. Because if you, if you're doing it for a long time, you know, two or three minutes is no big deal. But, you know, we have, I've seen procedures where pressure's been applied for 20 minutes.

We've had situations where we have to trade out. Because. You can't just stand there doing that for that long a time. I always educate people to have a step stool in the room because physicians want the bed or the cart elevated. That's hard on you to, to try to push, have pressure and not be able to use your body weight, but pushing, you know, upward or something.

I mean, lots of, lots of things can happen to not just the patients, but to the staff. So, you know, patient and staff safety are the two things that come to mind when you think of alternative ways of having pressure applied to patients. That's the most important thing is the safety of everyone.

Melanie Perry: Yeah, and that actually leads me to ask about training because I, to just use myself as an example, I've worked in the OR for many, many years, but I'd never worked in endoscopy until I came to my current facility. And my level of training was, well, you work in the OR, you must know how to do this too. And I'm like I've never seen this before. So I was taught how to chart, I was taught how to change the irrigation, and I was taught how to attach the polytrap thing that, that we put on when we're catching specimens.

And, you know, when I needed to plug in a bovie versus when we were fine. Like, I didn't. I didn't learn anything else other than that. And that was kind of, but it was also just kind of the assumption, well, that's just what you need to know. But obviously listening to you, there's a whole lot more that I need to know.

So how do you train your endoscopy nurses so that they are educated for their own safety and for patient safety?

Connie Hall: So I, kind of, when I have new nurses starting in the department, during their orientation, either myself or one of the people that I have trained to be the person to orient, I want to make sure you know anatomy. You know, if you are a tech, I don't expect you to have had an anatomy class. If you're a nurse, you should have. Lots of times it was so long ago that you don't remember anything.

Melanie Perry: Let me think real quick.

Connie Hall: Yeah, but you know, I want you to put your hands on a spleen, and I want you to know the difference between what a spleen feels like and what a liver feels like.

I didn't even touch on the liver, but that's also a possible injury that can occur. So, you know, I want you to have a basic understanding of the anatomy, certainly of the abdominal anatomy. Also, there's a book called The Core Curriculum that we call it the GI Bible, but that's like if you're studying for your certification exam.

It goes through every part of the GI anatomy, so new nurses are expected to read that. They need to know esophageal diseases, small bowel diseases, colon diseases, what the anatomy is, what different landmarks are. You know, that's my expectation. If you're a nurse working in this room, you understand what we're doing.

And then maybe not quite so extensive with techs because, you know, just the nature of what each job title is. But definitely understanding that abdominal anatomy because you're, they're usually the ones that are going to be applying the pressure and I don't want them hurting anyone and I don't want them getting themselves hurt.

Melanie Perry: Right, definitely. So beyond training your staff and you, you know, you, it sounds very thorough and I'm going to have to look this book up and brush up myself to make sure that I am the most educated I can be for when I'm in endoscopy. But I'm also curious, do y'all use any type of maybe screening tool with your patients to determine if you think maybe they are going to be difficult versus quote unquote easy for a colonoscopy.

Connie Hall: Yeah, I mean, there's a few questions that need to be asked You know if the patient shows up and they say I had a failed colonoscopy at a different facility. They couldn't get to the secum. Okay, well, there's a little red flag thrown up again if the BMI is extremely high or extremely low that also is an indicator that you know, we need to think this through before we even get started So those are really the main things, failed exams, and then just looking at the, the body habitus of those patients.

Melanie Perry: So then let's think about alternatives then, if we've obviously made a very good case here that just applying abdominal pressure is really not best practice, and it's not in the best interest of our patients or of our staff. What are the alternatives out there? Because The colon's not getting any more rigid, like it's going to stay floppy. So how do we splint that colon to do the procedure and not put people at risk?

Connie Hall: Well, fortunately there is a new product and I say new, but by new, I mean less than 10 years on the market and we've had abdominal binders again, back to the OR. There's abdominal binders in the OR that are placed after abdominal surgeries.

And I'm not saying those aren't an option, because they certainly are an option, but they're not the best option. And this company ColoWrap is out there now. I was not sold on ColoWrap when I first heard about it because I'm I don't like to add expense to anything. But then when you you know think about expense versus patient injury staff injury and even the amount of time involved, what I thought might be something expensive, turned out to not be be expensive at all when you count, you know, add in all the things that could go along with either not completing an exam or spending two hours on an exam that maybe you could get done in 20 minutes or not having a tech out for the next three months because they need carpal tunnel repair.

Melanie Perry: Yeah. Looking at the big, at the whole picture, not just one data point, but the whole picture. So I'm, I'm kind of, I'm curious, how did this wrap, how did it, how did your department get better, I guess, when you used it.

Connie Hall: So, we started a kind of a screening process at looking at, at some of the things I already mentioned, you know, if a patient showed up because they were a failed exam, there was a good candidate. We kind of set a BMI of greater than 30 as the potentially a really good candidate. Not all BMIs are the same, you know, if you're. 7 foot tall and you weigh 200 pounds, you know,

Melanie Perry: It's not the same.

Connie Hall: Again, look at your patient.

Melanie Perry: Right.

Connie Hall: And then same thing with the little 90 pound ladies and then good communication with your physicians.

I'm making it sound like it's a nursing call. It's not. I mean, we're all a team. And so working closely with our physicians to tell them what we've recognized and after a few months of having the product available, physicians would schedule a patient saying, need a ColoWrap.

Melanie Perry: Really? So you were able to get their buy in and change their practice.

And we all, all of us have experienced trying to bring an idea to a surgeon who's always done it a certain way. And they're not always, always the most open to new ideas or new things. So was it just a matter of educating your surgeons about what you were experiencing or did you do anything else for buy in?

Connie Hall: Well, it was a process, you know, I, you refer to surgeons, I refer to my GI doctors or who are not surgeons. I like to think they're probably easier to get along with than surgeons.

Melanie Perry: Maybe so.

Connie Hall: Um, but you know, just using some examples of someone tried this patient, you know, six months ago and they couldn't complete it.

Let's just try this and see what happens. And lots of times it was, they were the same physician, you know, we brought them back because, you know, whatever reason they had a lot of polyps and they were really hard to do. Why don't we try it this time with this? And really they only had to have success once or twice and they were, they were true believers.

I think it's very important to not present it. in a threatening fashion. Nobody wants their ego to be stepped on. And the way I would present it to my physicians is, I know you think this is about you, but it's really has nothing to do with you. And it has everything to do with my staff safety and the patient safety and what's best for the lab today.

I don't want to get two hours behind and pay overtime. If we can do this procedure in 20 minutes instead of two hours, you know, and, and really take, you know, Even though the physician was important, but take their ego out of it and really turn it back onto the patient.

Melanie Perry: Yeah.

Connie Hall: And the staff. And again...

Melanie Perry: It's less threatening that way, right. It's not about you.

Connie Hall: Yeah. Yeah. I mean, no, no physician wants to hear something's not about them, but sometimes it's not about them.

Melanie Perry: It's not for sure.

So, but that, that's good to know that, and also to know that you were empowered to have those discussions and to make that case for something that was in the best interest, not only of the patients, but also for your staff.

Because I mean, we've seen through this conversation, the risk is just as great to the staff as it is to the patients when we're talking about injury, when we're just applying manual abdominal pressure.

Connie Hall: And I will tell you, I had colorectal surgeons in my department who wouldn't even hear of using it until they, you know, we had a couple times where we had really large patients that the colorectal surgeons were doing the colonoscopy on, and we just put it on them without asking, you know, ahead of time, and then played dumb, like, oh, I didn't realize you didn't like to use them.

Melanie Perry: But look, it works.

Connie Hall: But look how easy that exam was compared to what you've done in the past. And I've converted a couple that, you know, had no interest and then realized, hmm.

Melanie Perry: Maybe it's not so bad.

Connie Hall: Yeah.

Melanie Perry: So, well, you know, an experience sometimes can be the best teacher or the best motivator for change. So, you know, we do what we have to do for our patients and our staff to keep them safe, so. As we wrap this conversation up, I actually want to go back to something you mentioned earlier about certifications and about, because I do think certification is so important and it really highlights our knowledge and expertise in this area.

And obviously you have a ton of experience and knowledge in. endoscopy and in this realm. But I'm curious, you mentioned your certifications and those are different than the ones that those of us in the OR have heard before. So can you tell me about your certifications?

Connie Hall: Yes. So CGRN is a certified gastroenterology registered nurse.

That certification has been around, I'm going to say 40, 45 years now. I'm actually on the board of the ABCGN, the American Board of Certified Gastroenterology Nurses. It's kind of like a CORN, it's an advanced certification within your specialty area. We really encourage it in GI nursing for a lot of reasons, but, you know, to maintain your certification requires continuing education.

And I think that if we don't take the time and the effort to keep ourselves continually educated, I don't know how we're going to stay ahead in this, in this ever-evolving, changing world of GI.

Melanie Perry: You are absolutely right.

Connie Hall: You know, there's just something new every day, new procedures, new ways of doing procedures, new scopes, new, I mean, you just name it. You know, so I, I preach certification. I think it's very important to, it's important to your patients. You know, when you're taking care of a patient and they say, what's, for some reason, when they see CGRN, they always think it says corn. You know, what's a corn? I'm just telling them, well, I'm corn fed, but, you know, it's, it's a certification that I've obtained to be more involved and up to date on everything GI-related.

Um, I also have a certified Certified Endoscopic Reprocessor Certification. Infection control is the hottest topic in GI anymore. And I felt like I wanted all my techs to be certified. So I took that exam first to make sure I thought the techs that it would be applicable to what they did. And it is. And I've encouraged many techs now to get out there and get themselves certified.

I also don't want CSPD to be reprocessing our scopes. So I think if we have certified techs, the longer we do that, the greater the odds of departments being able to keep their scopes in their department. So keep yourself educated. You owe it to yourself, and you owe it to your patients.

Melanie Perry: We are in the ever-changing world of healthcare and there's something new and improved or different almost every single day.

So staying up to date is, is the best way that we can provide that care. So, Connie, before we wrap this conversation up today, do you have any final thoughts, anything else you want to touch on before we conclude our conversation today?

Connie Hall: You know, I, I, I have a passion for GI. I love what we're doing for patients and we can't keep up. Patients are behind on screenings. If you have a family member that's 50 or above, 45 or above, get them in for a colonoscopy. But more importantly, if you have, family history of colon cancer. We don't know that for sure about every cancer that we deal with in this country right now, but we absolutely know colon cancer is a genetic cancer. Get your families checked, get your friends checked, get yourself checked. That's, that's my, stump speech for the day.

Melanie Perry: Well, that's the best one that we could end this with. So Connie, thank you so much for joining us today.

Connie Hall: Yeah, you're welcome. Glad to have, glad to help you out and glad to be involved.

Melanie Perry: That was Connie Hall, endoscopy supervisor at the University of Missouri in Columbia, Missouri, talking all things colonoscopy and the surprising risks that our patients and our staff are susceptible to when we are dealing with procedures that might not go as smoothly as originally planned. And I mean, honestly, I could sit and listen to her talk all day and learn from her because my level of training and experience in endoscopy is nowhere near what Connie's is.

And understanding the risks associated with applying abdominal pressure and what we're doing to our patients, what we can do to our patients, and then also how we can harm ourselves. It's very important. And I know that I'll think twice before I just randomly apply pressure again. Um, and also it's very helpful to discuss alternatives to applying manual pressure.

When we are doing these procedures, but that is going to do it for this special release episode. I encourage you to discuss the risks of applying manual pressure during colonoscopies with your, with your endoscopy director, with your surgery director and with others at your facility so that you can improve the patient experience and staff safety during those procedures.

On behalf of everyone here at First Case, thanks for listening to this week's interview with Connie Hall.

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