Successful applicants to the ASGE Endoscopy Unit Recognition Program 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 a proactive approach to successful inpatient colonoscopy preparation.
DEFINE
Achieving adequate bowel preparation is challenging and critical to achieve a good quality colonoscopy. Delays due to inadequate bowel prep interfere with medical care, require repeat procedure, and increase length of stay and cost of care.
MEASURE
After a baseline analysis, interventions for improving inpatient bowel preparation were implemented from 2019-2021. Data collected for measuring the impact of the interventions was the timing of prep completion, amount of prep consumed, utilization of salvage prep, adequacy of prep, repeat colonoscopies during same hospitalization due to poor prep and length of stay. The data was collected from [our electronic health records system] and medical chart review.
ANALYZE
The adequacy of prep, impact of salvage prep on colonoscopy readiness, repeat colonoscopies and length of stay were analyzed to show changes over time compared to baseline. Statistical significance was performed to identify the impact of the changes. Brainstorming among the quality director, GI fellows, nursing educator and [EHR] clinical team occurred to identify potential improvement opportunities.
IMPROVE
The interventions implemented in collaboration with the [EHR] team and nursing included the development of a new [EHR] order set for split-dose preps and a nursing workflow to assess for bowel cleanliness following prep intake. The [EHR] order set included timing for am/pm colonoscopies, options for high-risk patients who would need salvage prep and built-in nursing orders for patients unable to tolerate prep. Hard stops for nursing documentation were set up to ensure that all information was recorded regarding the amount of prep consumed. GI fellows did a 7:00 am check on the day of the procedure to ensure prep completion. Bowel prep assessment measured consistency, color and sediment of stool to identify readiness for colonoscopy to the GI lab by indicating green for readiness and red if not ready.
CONTROL
Post-intervention data showed a 17.6% reduction in inadequate preps from baseline (p=0.0005). Only 2.4% colonoscopies were repeated during the same hospitalization with only one 4-day increase in LOS. This was a 16.2% (p=0.0001) reduction from baseline. Cost savings were estimated at $56,869. The addition of salvage prep after same-day 7:00 am evaluation by GI fellows provided the greatest impact in bowel prep adequacy.
We hope sharing this project summary will be useful to you and your practice.