528 A Patient-Centered Multidisciplinary Approach to Improve Inpatient Bowel Preparation for Colonoscopy

Abstract

INTRODUCTION: The success of colonoscopy is largely dependent on the quality of bowel preparation. Inpatient colonoscopy preparations are often suboptimal, leading to missed lesions, increased complications and poor study quality. Several studies have shown improved outcomes with split-dose bowel preparation (SBDP). As such, we conducted a multidisciplinary approach to implement a universal prep protocol (UPP) for our hospitalized patients and assessed the intervention's impact on colonoscopy quality with the Boston Bowel Prep Score (BBPS). METHODS: We implemented a UPP for all our inpatient colonoscopy cases that met inclusion criteria. We initiated a patient focused multidisciplinary educational intervention to implement this UPP by administering SDBP (2L PEG at 5pm the night prior to colonoscopy and 2L at 5am the morning of colonoscopy). Educational interventions included holding multiple group meetings to educate house staff and floor nursing staff on how to order and administer the split doses. Patients and staff were educated on the benefits of split prep, how to pace bowel prep intake and dietary changes prior to colonoscopy. A universal pamphlet in English and Spanish reiterating these points was created and was provided to patients and staff for reference. Six months of prospective data, which included gender, ethnicity, indication for the procedure, and BBPS, were collected and compared to a historic pre-intervention (PI) cohort. RESULTS: A total of 155 patient records were reviewed, of these 107 eligible patients were identified. There was no statistical difference in age, ethnicity and indication between the two groups, but there was a difference in gender with 62% of PI patients being male compared to 35% males in the intervention group (IG). The gender was adjusted for in the Linear Mixed Model, which showed a statistically significant increase in BBPS in the IG (P = 0.019, OR 0.3948). CONCLUSION: Achieving adequate bowel preparation in the inpatient setting is challenging. Our study showed that a patient centered multidisciplinary approach to implement a UPP and emphasizing patient and staff education significantly improved the quality of colonoscopy, as demonstrated by the BBPS. This approach also highlights how patient engagement and patient comfort are key elements of patient focused care. Other institutions should consider this framework in improving inpatient colonoscopy quality and patient outcomes.