It’s All About the Prep: Improving Colonoscopy Bowel Preparation through Patient Instructions

Abstract

Colonoscopy is the most effective modality to detect and prevent colorectal cancer. The quality of bowel preparation is an important quality indicator for colonoscopy. An adequate bowel preparation requires the patient’s compliance with the preparation instructions. Currently, patients receive a copy of the instructions including the phone number of the on-call GI fellow who answers calls after hours. We aim to improve patient education and compliance with bowel preparation, as well as to educate the GI fellows on commonly used preparations and to provide standardized answers to questions frequently asked by patients. We hope to improve the overall quality of bowel preparation of our patients undergoing colonoscopy. We documented all of the patient phone calls received by the on-call GI fellows for 3 months including the questions asked by the patients, answers provided by the fellows and the quality of the preparation. We then designed a "Frequently Asked Questions and Answers" page based on the questions received to add to the bowel preparation instructions distributed to the patients. We also designed a short course for the GI fellows to review and discuss bowel preparations. We plan to document patient phone calls after the above interventions to determine if the frequency or the quality of phone calls have changed, as well as the quality of the bowel preparation. We are using data from GIQuIC to measure the overall quality of bowel preparation before and after the intervention. A total of 47 phone calls by 43 patients were received from October 10 to December 20, 2018. Out of the 47 phone calls, 38 (81%) of them can be categorized into one of the following 3 groups: no bowel movements after taking bowel preparation (18 calls), frequent bowel movements hoping to not have to complete the preparation (14 calls), or nausea/vomiting after taking the preparation (6 calls). Out of the 47 phone calls, 22 (47%) of them occurred between the hours of 10pm and 6am. After the phone calls, 9 (21%) patients cancelled their colonoscopy appointment, and 2 patients (4%) underwent scheduled virtual colonography. Out of the 32 patients (74%) who underwent their scheduled colonoscopy, the quality of their preparation was reported as excellent to good for 27 patients (84%), adequate for 1 patient (3%), fair for 2 patients (6%), and poor for 2 patients (6%). Based on GIQuIC data, 723 out 816 (88.6%) reported colonoscopies in our institution had adequate bowel preparation from October to December 2018. Patients often have similar questions regarding their bowel preparation. By providing easily accessible answers to these frequently asked questions, we hope to improve compliance and ultimately improve the overall quality of bowel preparation for scheduled colonoscopies.