S1292 Optimizing Endoscopy Procedure Documentation Improves Guideline Adherent Care in Upper Gastrointestinal Bleeding

Abstract

Introduction: Upper GI bleeding (UGIB) is a common indication forced inpatient esophagogastroduodenoscopy (EGD). Outcomes afterwards are often dependent in part by guideline-based post-EGD care. Our aim was to optimize and standardize documentation post-EGD in UGIB to improve clinical care. Methods: National guidelines were used to build optimized etiology- and severity-specific note templates at an academic tertiary referral center. 39 attendings and 15 fellows completed a 10 minute training session in template content & use. We collected pre- and post-intervention on “minimal-standard” (MS) report documentation including patient disposition, diet, & medications. We also recorded documentation of rebleed precautions, and follow-up procedures. Health outcomes measured included guideline-based medication prescriptions, ordering of follow-up EGD if indicated, and clinical cessation of bleeding after discharge. Results: Pre-intervention demonstrated 54% and 36% of 108 patients received guideline-based inpatient and outpatient proton pump inhibitor (PPI), respectively. At baseline, 67.6% were referred for standard-of-care repeat EGD and only 36.1% of reports met MS report criteria. After template implementation, of 309 EGDs for UGIB over 6 months, the templates were used in 72% of cases. Workload was reduced by a mean of 33 “clicks,” 356 free text characters and 2 minutes per report (Figure 1, Panel A). There was a significant improvement in documentation of disposition (63.0% to 74.1%, p=0.028), appropriate PPI use(57.1% to 69.8%, p=0.035), rebleed (22.2% to 44.3%, p< 0.001) recommendations, and MS report completion (27.8% to 40.8%,p=0.016). There was significant improvement in inpatient PPI administered (53.6% to 73.6%, p< 0.001), discharge PPI prescription(35.7% to 54.0%, p=0.004), octreotide regimen(79.2% to 93.2%,p=0.048) and follow-up EGD orde r(67.6% to 86.7%, p< 0.001) (Table 1). Template usage (64%-79%), process (38%-50%) and outcome(67%-95%) metrics remained high over 6 months (Figure 1, Panel B & C). Inpatient PPI compliance(71.7% vs 63.4%; p=0.069) and follow-up EGD orders (85.7% vs 77.3%;p=0.028) were improved with template use. Conclusion: Our project leveraged endoscopy software to standardize efficient provider documentation, resulting in improved clinical care. Our intervention required minimal implementation cost, low burden of maintenance, and sustainability with high utilization rates over 6 months. Similar endoscopy templates can be applied to other health systems and endoscopic procedures to improve the quality of care.Table 1.: Process and outcome metrics pre- vs post- intervention. Statistical analysis using X2 testing.Figure 1.: Panel A: Sample endoscopy documentation template, Upper Gastrointestinal Bleed High Risk Non-Variceal Panel B: Process metrics pre- vs post-intervention of template usage (circle), minimal-standard non-variceal report (square), minimal-standard report (all etiologies) (diamond), and minimal-standard variceal report (triangle) Panel C: Outcome metrics pre- vs post-intervention of compliance with coordinated repeat EGD (circle), inpatient PPI regimen (square) and discharge PPI regimen (triangle).