Adherence to Guidelines After Poor Colonoscopy Preparation: Experience From a Patient Navigator Program

Abstract

In 2012, the US Multisociety Task Force (USMSTF) issued guidelines recommending that colonoscopies with poor bowel preparation should be repeated within 1 year. To our knowledge, adherence to guidelines in cases of poor bowel preparation has not been assessed within patient navigator programs. We aimed to measure adherence to this recommendation for patients with poor or inadequate colonoscopy preparation in an urban academic patient navigator program. We retrospectively reviewed the medical records of patients who underwent colonoscopy through the direct-referral patient navigator program at an urban academic medical center in 2013 to determine whether patients with poor or inadequate preparation underwent a repeat colonoscopy within 1 year, as recommended by the 2012 USMSTF guidelines. Demographics and colonoscopy findings on index and repeat procedures were collected. Thirty-five of the 655 (5%) patient navigator colonoscopies performed by 8 providers had poor or inadequate preparation. Mean age of the 35 patients was 61.2 years (range, 45−81 years) and 20 (57%) were female. Thirty-two (91%) colonoscopies were for screening or surveillance indications, 32 (91%) achieved cecal intubation, 6 (17%) involved a trainee (fellow), and 11 (31%) patients with poor/inadequate preparation had at least 1 adenomatous polyp. A repeat colonoscopy was performed within 1 year in 26 (72%) patients with poor or inadequate preparation. Of the 35 index examinations, a recommendation to repeat within 1 year was documented in 21 (60%) of the colonoscopy reports: 8 of 10 (80%) in those that were repeated according to guidelines and 13 of 25 (52%) in those that were not. Of those that had appropriate repeat procedures after a report documenting this recommendation, 6 of 8 (75%) listed a repeat period within 6 months or less, compared with 3 of 13 (23%) from the group that did not have a repeat procedure. There is suboptimal adherence to the 2012 guidelines recommending a repeat colonoscopy within 1 year for patients with poor or inadequate colonoscopy preparation in a patient navigator program. This analysis suggests that adherence to guidelines can be improved by correctly documenting the need for a repeat procedure within 1 year or less in the procedure report.