A Comprehensive Intervention to Enhance Inpatient Colon Preparation Quality and Efficacy for Colonoscopy: 2016 ACG Presidential Poster Award

Abstract

Introduction: Safety, accuracy and utility of colonoscopy requires adequate colon preparation. This is particularly important for inpatients undergoing colonoscopy for acute diagnostic or therapeutic indications. Inadequate inpatient colon preparation has been associated with longer hospital length of stay and increased hospital costs. We report implementation of a quality improvement intervention to improve the quality of inpatient colon preparations. Methods: Reports from inpatient colonoscopies performed over 12 months were reviewed to assess baseline colon preparation quality as determined by the Boston Bowel Prep Score (BBPS). A comprehensive intervention to improve colon preparation quality was subsequently developed. The intervention had multiple, simultaneously-implemented, components including: Standardized, EMR-based, colonoscopy preparation order set (Figure 1); Automated EMR alerts to prompt nursing assessment of colon preparation progress; Standardized nursing charting processes for tracking progress of colon preparation (Figure 2); Standardized education for nursing staff and ordering providers on importance of adequate colon preparation, assessment of colon preparation quality, and use of the above processes; Use of standardized patient education materials. A 10-week pilot implementation of the intervention was undertaken and postintervention colon preparation quality assessed.Figure 1Figure 2Results: 239 inpatient colonoscopies were performed in the preintervention assessment period. Mean preintervention total BBPS was 6.7 (2.3 in left colon, 2.3 in transverse colon, 2.1 in right colon) and 22.5% of patients (n=54) had inadequate colon preparation (total BPPS < 6 or BPPS < 2 in any segment). 10 weeks after pilot implementation of the quality improvement intervention, colon preparation quality data was available on 31 patients. Of these, 6.5% of patients (n=2) had inadequate colon preparation. Mean postintervention total BBPS was 7.6 (2.6 in left colon, 2.7 in transverse colon, 2.3 in right colon), representing a 13.4% improvement in total BPPS following implementation of the quality improvement intervention. Conclusion: Use of a comprehensive colon preparation quality intervention resulted in improved inpatient colon preparation quality in this pilot implementation. The intervention is being implemented hospital-wide. The EMR-based processes and patient education materials are being refined. Data collection on colon preparation quality, hospital length of stay, and hospital costs is ongoing.