S206 Assessing Barriers for Inpatient Colonoscopy Preparation: A QI Project

Abstract

Introduction: Inpatient colonoscopies tend to have poor quality. Poor communication, adherence, advanced patient age, and comorbidities may impact bowel preparation. Poor preparation can increase procedure times, lower pathology detection rates, and increase cancellations causing delays in care. We aimed to identify the practices and knowledge surrounding inpatient colonoscopies at our academic center. Methods: Our electronic health record was queried for inpatient colonoscopies scheduled between 1/1/2019-3/31/2019. Details about the procedure, demographics, and outcomes were recorded. A survey of internal medicine residents and hospitalists was conducted to assess physician knowledge and experiences. A separate survey was conducted among nursing to evaluate their knowledge and challenges with the inpatient protocol. Results: Between 1/1/2019-3/31/2019, a total of 133 inpatient colonoscopies were scheduled. Patients had a mean age of 63.5 ± 14.2 years, with 58.5% female (n=62). The most common indications were iron deficiency anemia 28.3% (n=30), hematochezia 27.4% (n=29), and abnormal CT of GI tract 8.4% (n=9). Of the 133 scheduled procedures, 20.3% (n=27) were rescheduled or cancelled. The most commonly cited reason was poor prep quality (n=8), although a reason was often not documented (n=17). Additional bowel prep was ordered 45.3% of the time. Seventy-two physicians participated in the first survey: 77.8% internal medicine residents and 22.2% hospitalists. Only 37.5% (n=27) reported knowing when to alert gastroenterology about a patient who has not prepped adequately. 51.4% (n=37) reported they were "never" or "rarely" notified by nursing of a patient's poor progression. Only 23.6% (n=17) felt "very familiar" and one "extremely familiar" with the protocol. The most commonly cited reasons for poor prep were patient non-adherence and poor communication. Fifty-nine nurses participated in the second survey. Nearly 25% (n=14) were not familiar with the current inpatient protocol. 54% (n=32) of nurses reporting experiencing delays in receiving bowel prep from the pharmacy. Patient counseling and nursing education were cited as the two most important targets for improvement. Conclusion: Our next steps are to develop a protocol to standardize inpatient colonoscopy preparation. We anticipate a three-prong approach focusing on enhancing patient knowledge using educational materials, improving provider education of the preparation protocol, and increasing the efficiency of preparation delivery via pharmacy.Figure 1.: Provider and Nursing Familiarity with Inpatient Colonoscopy Preparation Protocol.Table 1.: Characteristics of Scheduled Inpatient Colonoscopies.