566 Improving Bowel Preparation Quality for Inpatient Colonoscopies at a Tertiary Hospital

Abstract

INTRODUCTION: Adequate bowel preparation quality is required for appropriate mucosal visualization during colonoscopy. Several factors impede quality including patient, environmental and process factors. When colonoscopies demonstrate poor-quality preparation, it often delays further management and discharge for patients as they often need to return for a second procedure in order to get adequate visualization. This also results in increased costs to the healthcare system. Our aim was to identify the rate of poor-quality bowel preparation at our tertiary care hospital for inpatient colonoscopies and implement interventions to decrease this rate. METHODS: The study was conducted at University Hospital in London, Ontario from March 2018 - March 2019. In the first PDSA cycle we improved an existing order-set such that split- dose bowel preparation would more reliably be ordered and administered. Our second PDSA cycle focused on teaching junior residents how to order bowel preparation for inpatient colonoscopies. PDSA cycle three involved making bowel preparation quality assessment more objective. Lastly, PDSA cycle four wasaimed at improving patient education surrounding the importance of completing bowel preparation. RESULTS: Poor-quality bowel preparation in the six months prior to intervention was 14.0%. After intervention this came down to 8.0%. Similarly our process measure of patients receiving split-dose bowel preparation administration increased from 81.2% to 94.6% during this period. CONCLUSION: Several factors are involved with poor-quality bowel preparation for inpatient colonoscopies. Simple and sustainable interventions can be implemented to improve quality. We are continuing to identify new factors and interventions to further improve this metric.