Abstract 11 Assessing the Success of a Multidisciplinary Quality Improvement Initiative to Improve Outpatient Screening Colonoscopy Bowel Preparation

Abstract

The quality of screening colonoscopy preparation is dependent upon pre-procedural bowel preparation. An abundance of poor and fair bowel preparations during screening colonoscopies at our tertiary care, a university ambulatory endoscopy center, prompted a quality improvement (QI) initiative to enhance screening colonoscopy quality and efficiency. A multidisciplinary team comprising Gastroenterology faculty and fellows, endoscopy nurses, and procedure schedulers was assembled. Current scheduling workflow, screening colonoscopy bowel preparation protocols, patient informational handouts, and relevant published literature were reviewed. Several changes were implemented: prescribed bowel preparations were standardized into 1 of 2 choices ‘Standard Bowel Prep’: split-dose 4L polyethylene glycol solution, or ‘Miralax Plus Prep’: 5 days of polyethylene glycol 3350 (MIRALAX) 17g twice daily plus the Standard Bowel Prep. The latter was chosen for prior poor bowel preparation, opioid use, or chronic constipation. Standardized dietary instructions were used; patients were asked to avoid corn, beans, and vegetables for 3 days. A simple, colorful, pictorial description of a clear liquid diet was designed. The procedure schedulers and endoscopy nurses received additional training on educating patients about effective bowel preparation, with the use of newly designed visual aids. Endoscopists applied the validated Boston Bowel Preparation Score (BPSS) to grade the bowel preparation immediately post procedure. χ2 test for proportions and paired t-test for means were used to test for statistical significance. Records of 776 consecutive patients who had screening colonoscopy between January—August 2016 were reviewed; 388 prior to the QI initiative implementation date (April 21 2016), and 388 post-intervention. Males and females were equally represented (388 each). Post intervention, the mean Boston Bowel Preparation Score (BBPS) was 7.3, corresponding with excellent bowel preparation. Over half (52%) of post-intervention bowel preparations received a perfect score of 9. There was a significant increase in optimal (good + adequate + excellent) bowel preparations (63.3% to 82.4%), and a corresponding drop in fair (23.8% to 13.9%) and poor (13.9% to 3.6%) post-intervention. The number of aborted procedures because of suboptimal bowel preparation decreased from 13 pre-intervention to 5 (P = .03; Table 1). The mean procedure duration of screening colonoscopies without polypectomy was significantly lower post-intervention compared with pre-intervention group (from 16.4 minutes to 15.1 minutes; P = .04). This QI initiative demonstrates that a multifaceted approach to improving the quality of colonoscopy preparation can be executed in a brief time. The multidisciplinary team implemented standardized bowel preparations, dietary counseling, and pictorial dietary reinforcement, which improved the quality of screening colonoscopy bowel preparations and reduced both the number of aborted procedures as well as duration of screening colonoscopy without polypectomy.