645 Implementation of Fecal Immunochemical Testing Is Associated With Higher Screening Rates in a Safety-Net Population

Abstract

Methods: A nurse delivered pre-procedure phone call for all scheduled procedures was instituted in October 2013 at a single tertiary care endoscopy center. In addition to standardized bowel prep instructions received in the mail, the nurse would call 2-7 days prior to the procedure to discuss the prep instructions in a scripted manner. The standard preparation used was bisacodyl 15mg and Miralax-Gatorade (238g of PEG-3350 in 64oz of Gatorade) in a non-split dose regimen. We performed a retrospective cohort study using the EndoWorks® database (Olympus America) and EPIC medical record (Epic Systems Corp., Verona, WI). All colonoscopy records from October 2012 to February 2013 (control, n = 1928) and October 2013 to February 2014 (intervention, n = 2088) were queried. Colonoscopy and pathology records were reviewed for patient demographics, indication, reported prep quality on the Aronchick scale, adenoma and sessile adenoma detection, size and location of polyps and incomplete procedures. In-patient (n = 115, 106) and diagnostic/therapeutic procedures (n = 702, 769) were excluded from the final analysis. Results: Patient demographics and procedure indication were similar amongst the control (n =1221) and intervention (n = 1309) groups on the basis of age (59.5 + 10.1 v. 59.8 + 9.8, p = .56), male gender (45.2% v. 48.7%, p = .08) and indication: screening (42.1% v. 41.1%, p = .55) and surveillance (21.5% v. 22%, p = .73). Of the colonoscopies performed for a screening indication, there was no difference among the control (n = 808) and intervention group (n = 854) in the rate of adequate preparation (78% v. 74.4%, p = .08), ADR (30.3% v. 28.9%, p = .53) including detection of right sided adenomas less than 5mm (7.1% v 7.6%, p = .66), sessile serrated adenoma detection rate (3.3% v. 4.5%, p = .24) or incomplete examination (6.2% v. 4.7%, p = .18). If colonoscopy performed for adenoma surveillance is added, there was no difference among the control (n = 1221) and intervention group (n = 1309) in adenoma detection rate (35.3% v. 35.4%, p = .997). Conclusion: A nurse delivered pre-procedure phone call to discuss bowel preparation prior to colonoscopy has no effect on adequacy of bowel preparation, adenoma detection or incomplete examinations.