Practice Management

Successful applicants to the ASGE Endoscopy Unit Recognition Program (EURP) submit a summary of a recently conducted quality improvement (QI) project as part of the application process. The QI project in the spotlight this month looks at colonoscopy preparation.

Purpose of study

During physician peer review meetings in January 2021, physicians reported a significant increase in incomplete and aborted colonoscopies due to suboptimal bowel cleanses in the past three months.

Colonoscopy remains the standard in colon cancer screening and prevention. Inadequate colon preparation could result in poor mucosal visibility, leading to low adenoma detection rates, which could result in an increase in adenocarcinomas.

The purpose of this study was to increase the quality of bowel preparation.

Performance goal

Two percent or less incomplete and aborted procedures as evidenced by data reports created in [the unit’s endoscopic report writer].

Data to be collected

Data reports were to be collected using the timeframe October 1, 2020 – December 31, 2020, including successful, incomplete and aborted colonoscopy procedures.

Evidence of data collection

Baseline data were collected using the timeframe 90 days prior to the reported increase in suboptimal bowel cleanses; the dates data were collected were October 1, 2020 – December 31, 2020, due to physicians reporting incomplete bowel cleanses in January 2021.

Data analysis. Does the problem actually exist? What do the data say about the frequency, severity and source of the problem?

• The review of data reports indicated that in the timeframe of October 1, 2020 – December 31, 2020, the number of canceled, incomplete and aborted colonoscopies was 22 of 768 total examinations, equaling approximately 3 percent of procedures.
• These data do not specifically list reasons for the cancellation of procedures; however, successful, canceled and aborted procedures were monitored for an upward trend.

The data identified that a problem did exist. Frequency was notable, and severity was moderate.

The sources of the problem, per committee evaluation of data and review of current colonoscopy cleanses, were potentially identified:

• Possible length of time from completion of bowel cleanse to scheduled procedure time
• Patients with multiple comorbidities, potentially causing poor-quality bowel cleanses

Compare current performance versus performance goals

A total of 768 colonoscopies were scheduled in the data collection period; 3 percent were noted. This did not meet the performance goal of 2 percent or less.

Corrective actions

• A focus group met to discuss current bowel cleanses and the request from physicians to mimic the Cleveland Clinic, Florida, bowel preparation.
• Physicians were asked to rate the quality of bowel cleanses over a four-week period April 1, 2021 – May 6, 2021, using the Ottawa Bowel Preparation Scale.
• Upon reviewing collected data, physicians reported an increase in quality and visibility with the current bowel preparation. Patients were tolerating preparation and adhering to NPO (nothing by mouth) guidelines as well.
• Remeasurement of data was set to be completed in six months in December 2021.

Remeasurement of data

1. Describe the data that was actually collected. A data report was created in [the unit’s endoscopic report writer] using successful, incomplete and aborted procedures for the timeframe of October 1, 2021 – December 31, 2021.
2. What do the data say about the source of the problem? After a review of the report, data indicated that the number of incomplete and aborted examinations decreased to 2 percent.

Additional actions and remeasurement

The initial corrective action achieved the goal that was set. The study was completed on December 31, 2021. The center will continue to periodically monitor to ensure compliance of 2 percent or less.

Were the QI study and its results reported to the governing body?

Yes, the initial phase of this study was presented to the governing body in August 2021. The completed study was discussed at the quality assurance meeting in the fourth quarter of 2021. Data and remeasurement were reviewed during the August 2022 governing body meeting.

We hope sharing this project summary will be useful to you and your practice. Learn more about gaining honoree status in the ASGE Endoscopy Unit Recognition Program. EURP honoree units may use the ASGE Quality Star logo in promotion of their units, receive premium educational content bimonthly via an exclusive e-newsletter The Huddle and enjoy a range of additional benefits. Questions should be directed to eurp@asge.org.