S150 Improving Inpatient Colonoscopy Preparation: A Quality Improvement Initiative at an Academic Medical Center

Abstract

Introduction: Inadequate bowel preparation for inpatient colonoscopy occurs in 75% inpatient colonoscopies, which leads to delays in patient care, inefficient use of endoscopy resources, decreased patient satisfaction with repeated preparation requirements. Our quality improvement study seeks to improve inpatient bowel preparations at a large academic medical center with a goal of reducing the number of delayed inpatient colonoscopies due to poor preparation by 50% in 6 months. Our equity aim in this project is to improve bowel preparation in non-English speaking patients and assess if a disparity in outcomes exists. Methods: We created an interprofessional team of medical residents, attendings, nurses, nurse managers, and gastroenterology fellows to create a process map and fishbone diagram to accurately portray the issue and identify measures and areas for improvement following the Institute for Healthcare Improvement model framework, Baseline data was collected for one month. For our first PDSA (plan-do-study-act) cycle, we initiated regular housestaff education on the importance of inpatient bowel prep through participation in noon conferences reaching 34 internal and family medicine residents and interns. Additionally, a one-page summary document was uploaded to the shared server for reference for all staff and education emails were sent to various nurse practitioner teams. Results: Three main areas in the fishbone and process map were identified as potential intervenable areas: communication, diet, and bowel preparation ordering. Of the 42 inpatient colonoscopies in the month prior to intervention, 31% were delayed due to poor colonoscopy preparation. Delays decreased to 20% (7/34) in November and improved with outliers in the spring (see Figure for a Run Chart). One-fifth of delayed colonoscopies occurred in non-English speaking patients compared to 78% English-speaking patients. Conclusion: The initial data from our first round of interventions support an improvement in inpatient bowel preparation from education that has not yet reached the goal. Standardization is a key strategy to improve bowel preparation. Our next PSDA cycle includes the development of a standardized order set as well as a multi-pronged approach to address potential disparities in how we prepare our non-English speaking patients for their inpatient colonoscopies.Figure 1.: Run Chart. The arrow represents the time of the interventions. Each point is the average of poor colonoscopy preparation out of all colonoscopies performed for admitted patients that week. The blue arrow indicates when the interventions began.