Date of Award

Spring 5-31-2026

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Kevin J. Maxwell, PhD, DNP, FNP-BC, RN

Abstract

Background: Colonoscopy is the gold standard for colorectal cancer (CRC) screening and diagnosis, and demand for timely access continues to rise as screening guidelines expand and early-onset CRC increases. Efficient, safe sedation practices are essential to maintaining procedural capacity and ensuring high-quality recovery. Variability in communication between endoscopists and anesthesia providers during propofol-based sedation contributes to oversedation and delayed emergence, defined as a slower-than-expected return to baseline consciousness and airway reflexes after propofol cessation. These factors, in turn, prolong post-anesthesia care unit (PACU) stays and create workflow bottlenecks. The Communication-Led Evidence Aligned Recovery (CLEAR) workflow was developed to standardize interdisciplinary communication and align propofol titration with procedural progress.

Purpose: This quality-improvement pilot aimed to evaluate whether a structured “cecum time” cue, paired with an anatomically guided propofol-titration pathway, could reduce oversedation, improve emergence quality, and shorten PACU length of stay (LOS) in an outpatient endoscopy center.

Methods: A pre-/post-design compared 30 baseline colonoscopy encounters with 30 post-implementation cases. The intervention introduced a standardized communication cue and an anatomic checkpoint-based titration sequence. Fidelity checklists assessed cue reliability and titration adherence. Procedural, anesthesia, and PACU data were extracted from the electronic health record. Nonparametric analyses, including the Shapiro-Wilk and Mann-Whitney U tests, were used because the distributions were non-normal.

Results: CLEAR improved communication reliability, adherence to sedation titration, recovery efficiency, and operational outcomes. PACU length of stay (LOS) decreased from 36 to 28 minutes (22.2%), and time to discharge readiness decreased from 43 to 35 minutes (18.6%). Aldrete scores on PACU arrival increased from 7.5 to 8 (6.7%). Propofol exposure decreased by 21.9%, and the narrower interquartile range indicated reduced practice variation. Operational gains recovered 156.8 PACU minutes (2.6 hours) per provider per day, supporting an estimated 15% increase in throughput. No airway interventions, hemodynamic rescues, or adverse events occurred.

Conclusion: A simple, communication-driven workflow significantly improved emergence quality, recovery efficiency, and operational performance without compromising safety. CLEAR demonstrates that structured interdisciplinary communication and anticipatory titration can reduce practice variation and strengthen system-level performance in high-volume endoscopy settings. These findings support the feasibility of CLEAR as a low-burden, evidence-aligned strategy to optimize sedation safety and recovery during colonoscopy.

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Available for download on Thursday, May 11, 2028

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