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Multidisciplinary approach significantly improved inpatient colonoscopy bowel prep outcomes
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PHILADELPHIA — The creation of a clinical care pathway through a multidisciplinary effort, multifaceted educational efforts, and IT interventions significantly improved inpatient colonoscopy bowel preps at an academic center, according to study results presented at the American College of Gastroenterology Annual Meeting.
“The reason that inpatient bowel preps are important is because an unsuccessful inpatient bowel prep has several significant negative effects,” Alexandra T. Strauss, MD, MIE, of Johns Hopkins Medicine, said during her presentation.
Strauss said that an inpatient status alone has been demonstrated to be associated with inadequate bowel preparations due to acutely ill patients and logistical challenges.
“We cannot expect the same bowel prep we would use on a healthy, young patient to be equally successful for our ... inpatient,” she said.
Strauss elaborated and said that an inadequate inpatient bowel prep can lead to delayed diagnoses, increased length of stay and an added cost of approximately $1,000.
As a result, Strauss and colleagues developed a clinical care pathway using health systems engineering principles in an attempt to improve inpatient bowel prep outcomes.
A multidisciplinary team of residents, fellows, GI attendings, endoscopy nurses, and anesthesiologists and pharmacists were formed, and a literature review was conducted.
Strauss said that after the literature review, the team identified that inadequate inpatient bowel preps occur because of problems in six areas:
- Patients;
- Timing;
- Supplies;
- Providers;
- Orders; and,
- Communication.
Strauss and colleagues then conducted a single academic center retrospective chart review and developed a Quality Improvement initiative to assess pre- and post-intervention inpatient colonoscopy bowel prep outcomes.
There were 121 patients among the pre-intervention group and 129 patients in the post-intervention group.
Additionally, there was evidence of a sustained improvement in the post-intervention period (P < .0001).
Strauss said that after evaluation, it was determined that the increased inpatient colonoscopy bowel prep outcomes could lead to a minimum savings of $260,000.
“Inpatient bowel preps can be improved at the patient, provider, and system level by creating a successful clinical care pathway with a multidisciplinary team, multifaceted education, and IT intervention,” she said during her conclusion. “Improving bowel prep with health system engineering principles can lead to improved diagnostics, decreased length of stay and cost, and a reduction in exposure to unnecessary harm, such as anesthesia and procedural complications.” – by Ryan McDonald
Reference:
Strauss AT, et al. Abstract 4. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.
Disclosure: The researchers report no relevant financial disclosures.