Tu1165 CHARACTERIZATION AND FINANCIAL BURDEN OF PATIENTS WITH INADEQUATE AND INCOMPLETE BOWEL PREP AT AN ACADEMIC TERTIARY CENTER-- A PILOT STUDY

Abstract

Bowel prep is inadequate in one third of all inpatient colonoscopies even after educational interventions and regimen variations. Incomplete intake of bowel prep by inpatients may go unrecognized by the gastroenterologist until the procedure date, creating unnecessary delays and extending hospital admission and/or requiring repeat colonoscopy. Focusing on nausea, prep quantity consumed and need for delay, we aimed to identify modifiable risk factors for inadequate bowel prep, and estimated the burden to the healthcare system of suboptimal inpatient bowel prep. We prospectively collected data for all inpatient colonoscopies in a tertiary center from July-November 2019. We excluded patients who prepped via feeding tube or with planned extended prep, and emergent colonoscopies. We collected demographics, amount of prep consumed, prep duration, nausea, antiemetic use, delays due to incomplete prep, and prep quality. We grouped patients by adequacy of prep, time to prep completion, and nausea. Avoidable charge estimates, obtained from www.healthcarebluebook.com and the hospital billing department, were calculated based on need for repeat colonoscopy (including technical and professional charges for colonoscopy with anesthesia) and avoidable admission days. We identified 74 colonoscopies that met inclusion criteria: 71 used polyethylene glycol (PEG) with electrolytes, and 3 PEG. 2 were canceled for prep intolerance. 16 (22%) patients had inadequate bowel prep. These patients accounted for nearly all incurred avoidable healthcare charges (Table 1). 9 (12%) patients required delay of ≥1 day for additional prep, totaling 12 extra admission days. 12 (17%) needed an extra half day. These 21 patients (Delay) had more nausea, lower prep quality and more inadequate prep (RR=4.05) despite consuming more prep, and incurred considerably more avoidable healthcare charges ($68,350 vs. $28,050) even while excluding the 12 half-day delays (Table 2). 12(17%) patients had nausea, 7 received antiemetics. These had high risk of delay (RR=2.5), trended to increased risk of inadequate prep, and incurred avoidable charges at a higher rate (Table 2). Antiemetic use did not improve outcomes. In a tertiary center, nearly one quarter of inpatients have inadequate bowel prep and 30% require cancellation or delay due to incomplete prep at scheduled procedure time. Over a 5-month period this created an estimated $96,400 of avoidable healthcare charges. Need for delay is an important risk factor for inadequate prep. Nausea is a risk factor for procedure delay and possibly for inadequate prep too. These are potentially modifiable risk factors. While this study does not show efficacy of antiemetics or delays for additional prep, further study of proactive and preemptive management of patients at risk for delay and inadequate prep is warranted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)