S341 Implementation of a Direct Access Colonoscopy Program in a Resident-Run Continuity Clinic: A Real-World Experience

Abstract

Introduction: This quality improvement initiative was designed to assess and improve on the current method of referring patients for their age-appropriate colon cancer screening. We questioned whether a direct access referral model would prove to be a faster and more effective method to reduce patient time to colonoscopy and improve colonoscopy compliance rates. Methods: Through the Direct Access Colonoscopy (DAC) program, low-risk patients, due for their age-appropriate colon cancer screening were chosen to participate. Internal medicine residents completed a patient screening form, which was faxed directly to the gastroenterology surgical coordinator; subsequently a telehealth visit was done prior to colonoscopy. Non-DAC patient referrals were handled by the clinic referral coordinator through the prior established approach. Both patient groups were analyzed during the same period of time, from July 1, 2020 – March 1, 2021. Primary outcomes measured included the time from the referral date to performed colonoscopy date. Secondary outcomes included adverse reaction to preparation or procedure, and anesthesia complications. Results: 85 patients were included in the study, 48/85 (56%) women with a mean age of 59 ± 7 years, see Table 1 for baseline characteristics. The Direct Access Colonoscopy (DAC) cohort had a significantly improved time from referral to colonoscopy procedure with a mean time of 41±30 days vs 89 ± 52 days for Non-DAC group (P=0.03). No immediate complications or adverse events were documented for patients in both groups. Compliance rates of patients completing their colonoscopies, were higher, regardless of time to colonoscopy procedure for the DAC group 8/27 (30%) compared to the Non-DAC group 11/58 (19%), however it was statistically non-significant (P=0.2719). Conclusion: The DAC referral pathway provides a safe and time effective intervention, thereby reducing the wait time to colonoscopy in low-risk, age-appropriate colon cancer screening patients. The timing of our study during the coronavirus (COVID-19) pandemic has limited the studies absolute potential. However, despite the overall decreased numbers of procedures during this time, our study was able to effectively decrease the time to screening colonoscopy and improve patient education on colon cancer screening and emphasize the importance of preventative health. We encourage primary care clinics to implement the Direct Access Colonoscopy referral modality in an effort to improve colon cancer screening rates.Table 1.: Baseline characteristics of patients stratified based on DAC vs Non-DAC