S619 Open Access Colonoscopy: A Study on Indications, Appropriateness and Efficiency of Colonoscopy Referrals in a Tertiary Care Center

Abstract

Introduction: Open access colonoscopy (OAC) refers to screening colonoscopies ordered by primary care providers (PCP) without a specialist’s evaluation. In our institution, referral candidacy is based on specific parameters including a PCP visit within 6 months, controlled chronic conditions, normal laboratory values, and no gastrointestinal (GI) complaints. All referred patients are reviewed by a nurse, and patients that do not meet these criteria are considered rejected from OAC. OAC is currently challenged by inappropriateness of referrals and low follow-up rates. We sought to assess the rate of inappropriate OAC referrals, effectiveness of OAC, and identify most common reasons for rejection. Methods: This retrospective study was conducted at a large tertiary care center. All patients referred to OAC in October 2020 were included and a random sample of 200 patients was selected for manual chart review. Data collected includes: demographics, comorbidities, date of approval/rejection, reasons for rejection, and rates of colonoscopy completion. Results: Of the 200 patients reviewed, 1 was removed due to incomplete data. Of the remaining 199 patients, the mean age was 61, 98 (49%) were female, 79 (44%) were white, and 86 (48%) were black. A total of 114 (57%) were approved for OAC, of which 63 (55%) completed their colonoscopies with a mean of 121 days post-approval (SD=107, range 5-498 days). A total of 85 (43%) were rejected from OAC. The most common reasons for rejection included high risk comorbidities (26%), outstanding/abnormal laboratory results (21%), active GI conditions (18%), not due for colonoscopy (11%), uncontrolled diabetes (A1c >10; 7%), uncontrolled hypertension (1.2%) and lack of PCP visit within 6 months (4%). Among the 85 rejected patients, only 31 (36.5%) followed up with GI/PCP, of whom 21 (24.7%) underwent a colonoscopy. There were no significant differences between the accepted and rejected groups regarding age, gender, ethnicity, or insurance. (Table) Conclusion: Our study revealed that OAC continues to be significantly burdened by the high rate of inappropriate referrals that lead to delays in patient care and increased resource utilization. Rejected patients have low follow up rates and lower colonoscopy completion rates. As OAC use continues, future studies should assess the efficacy of various interventions targeting current flaws in the referral process to help achieve higher rates of successful and more efficient colon cancer screening. Table 1. - Summary of patient demographics and OAC approval/rejection data All Patients(N=199) Age (Mean ± SD) 61.4 ± 8.7 Gender FemaleMale N (%) 98 (49.2%)101 (50.8%) Race WhiteBlackOther N (%) 79 (43.6%)86 (47.5%)16 (8.8%) ApprovedOAC referrals Approval rate N (%) 114 (57.3%) Colonoscopy completion rate N (%) 63 (55.3%) Duration between OAC approval and colonoscopy completion (Mean days ± SD) 121.3 ± 107.4 RejectedOAC referrals Rejection rate N (%) 85 (42.7%) Colonoscopy completion rate N (%) 21 (24.7%) Duration between OAC rejection and colonoscopy completion (Mean days ± SD) 129.8 ± 96.4 Reason for Rejection High Risk ComorbiditiesOutstanding/Abnormal LabsActive GI ConditionNot Due for ColonoscopyNo PCP Visit in Last 6 MonthsOther N (%) 22 (25.8%)18 (21.2%)15 (17.6%)9 (10.6%)3 (3.5%)18 (21.3%)