S3128 A Quality Improvement Project to Improve Bowel Preparation Scores Using an Educational Video

Abstract

INTRODUCTION: Inadequate bowel preparation is a problem affecting a quarter of all colonoscopies in the United States across all populations. Measures to improve preparation compliance are needed to significantly reduce colonoscopy costs. The aim of our study was to prospectively assess the real-world effect of an educational intervention in the form of a video on patients undergoing outpatient colonoscopies. Unlike previously studied populations, this population is a diverse population with a significant proportion of underserved patients. METHODS: This historical cohort study utilized a prospectively maintained database ProVation to review outpatient colonoscopies at two hospital sites three months before and after an educational video detailing preparation instructions was implemented in April 2019. After scheduling for outpatient colonoscopy an educational video detailing bowel preparation instructions was shown to all patients seen in gastroenterology clinic. The video included instructions with pictures to enhance the standard written instructions for the preparation process, it also included examples of an adequately prepared colon versus poorly prepared colon to reinforce the importance. Patients underwent colonoscopy and the bowel preparation was evaluated immediately post procedure using the Boston Bowel Preparation Score or the Aronchick scale. The primary end point of the study was to evaluate the quality of bowel preparation before and after the educational video. RESULTS: There was no improvement in bowel preparation scores in either location, private or tertiary institution, using a categorical (fair/adequate/good/excellent as equivalent to BBPS 6, poor/inadequate < 6) or mean numerical bowel preparation score analyzing the BPPS scores only. Bowel preparation scores were no different after the video was implemented for screening colonoscopies nor for any other indication. CONCLUSION: The bowel preparation process is the most important factor for adequate colon cancer screening and surveillance.In this study, unlike previously published studies, patient education in multiple forms, including written instructions, pictorial representations, and video had no effect on bowel preparation rates. This suggests that a single approach may not be generalizable to all populations or to all health literacy levels.