2833 Too Open for Business? Audit of Our “Open Access” Colonoscopy Program

Abstract

INTRODUCTION: Open access colonoscopy programs are designed to decrease barriers to colorectal cancer (CRC) screening and streamline processes for patients and providers. Appropriate pre-procedure selection and patient education around bowel preparation are essential to successfully complete screening. We performed an audit of the current open access program at our urban, tertiary care university hospital in an effort to determine utilization of our program and quality of procedures for participating patients. METHODS: We performed a prospective analysis of the first, consecutive 100 patients enrolled for open access colonoscopy from February – May 2019. Patients answered standard screening questions about medical history to determine eligibility for open access CRC screening. To account for all patients, the electronic health record was modified for schedulers to designate patients as 'open access' at the time of scheduling. Patients were followed over the subsequent three months to determine show rate, reasons for incomplete procedure, quality of screening examination and findings on colonoscopy. RESULTS: A total of 98/100 patients were included for analysis (excluded two patients inadvertently designated as screening colonoscopy). The average screening age was 56 (range 45 - 73) with the majority females (62%). The overall show rate for scheduled procedure was 74/98 (75.5%). Of the 24 patients who did not show for scheduled procedure, 12.5% required pre-procedure cardiology clearance, 12.5% did not have appropriate in-network insurance, 12.5% did not complete bowel preparation, 8.3% cancelled for personal reasons and 54.2% did not show and could not be reached for follow up. There was no statistically significant difference between no-show rate depending on the PCP's affiliation: health system [14] vs. outside referral [10]). For those completing colonoscopy, 14.9% (11/74) had poor prep, 10.8% (8/74) had fair/adequate prep and 74% (55/74) had good/excellent prep. The most commonly prescribed bowel regimens were 4L PEG (53%) and 2L PEG + Vit C (22%). CONCLUSION: Despite a majority of patients completing colonoscopy for CRC screening, a significant group of patients did not complete screening through our open access system. By performing an audit, several barriers were identified that can be modified in future quality improvement projects to maximize open access success and completion rates.