How Can the Quality of Inpatient Colonoscopy Be Improved? A Randomized Prospective Study

Abstract

Background: Inpatient status is one of the most significant predictors of poor bowel prep quality in patients undergoing colonoscopy. Clinical factors more prevalent in inpatients may contribute to this poor outcome. These include older age, impaired mobility, higher number of medications, and the lack of proper pre-procedure education. Aims: 1. To determine if enhanced patient education can significantly improve the quality of bowel prep and 2. To prospectively identify other factors that may lead to poor bowel prep quality. Methods: This was a single-blind, randomized, prospective study. Inpatients scheduled for colonoscopy were randomized to two groups; the “education” (intervention) group received a 10-minute personal education and a pictorial brochure specifically formulated for this purpose. The “standard of care” (SOC) group did not receive this session or brochure. All pts received PEG (Golytlely®). Demographics, prevalence of concurrent medical illness and use of medications that can influence bowel prep outcome were documented. Patient compliance with bowel prep regimen was obtained from nursing staff. Endoscopists blinded to patient compliance data or randomization used a visual analog scale to score bowel prep quality, ranging from 1 to 5 (1 = poor prep quality, 5 = excellent prep quality). Results: 51 patients were randomized to the SOC or education group. Demographics, the frequency of concurrent medical condition, and medication used were similar in both groups. Patients in the education group consumed an average of 91% of their bowel prep solution vs. 77% in the SOC group. More than 66% (14/21) in the education group received bowel prep score above 4 (good prep quality) in comparison to only 30% (9/30) in the SOC group (p < 0.01). Consuming more than 80% of their bowel prep was a significant predictor of good bowel prep quality (p < 0.001). No other factors (gender, chronic medical condition, mobility and medication) contributed to the outcome in statistically significant manner when the good prep group was compared with the bad prep group. Furthermore, one out of ten patients in the SOC group required extended hospitalization to repeat colonoscopy as an inpatient. Conclusion: 1. Enhanced education of inpatients undergoing colonoscopy significantly improves the quality of colonoscopy. 2. Patient compliance is the single most important factor in determining prep quality. 3. Surprisingly, other clinical factors had little impact on prep quality. 4. Poor prep quality can increase length of hospital stay and financial cost to patients. Efforts to improve the quality of bowel preparation in inpatients should focus on patient education.