Endoscopy software improves clinical care after EGD
LAS VEGAS – A novel guideline-based template standardized efficient documentation and improved clinical care after esophagogastroduodenoscopy, according to research presented at ACG Annual Scientific Meeting.
“Upper gastrointestinal bleeding (UGIB) is a common indication for inpatient EGD,” Timothy Yen, MD, of the University of Colorado Anschutz Medical Campus, said during the presentation. “Outcomes afterward have often been dependent, in part, by guideline-based post-EGD care.”
To optimize and standardize documentation after EGD for UGIB care, Yen and colleagues built etiology and severity-specific note templates based on national guidelines. They collected data on pre-intervention and post-intervention “minimal-standard” report documentation on patient disposition, diet and medication as well as recorded documentation of rebleed precautions and follow-up procedures. Recorded health outcomes following template administration included prescribed medications, ordered follow-up EGD and clinical cessation of bleeding after discharge. Included attendings (n = 39) and fellows (n = 15) underwent a 10-minute training session on template content and use.
Prior to intervention, 108 patients received either guideline-based inpatient proton pump inhibitors (54%) or outpatient PPIs (36%); baseline measures revealed standard-of-care repeat EGD among 67.6% of patients with only 36.1% of reports meeting minimal-standard criteria.
Following template implementation in 309 EGDs for UGIB, researchers noted template usable in 72% of cases. The template reduced workload and improved documentation of disposition (63%-74.1%), appropriate PPI usage (57.1%-69.8%), rebleed recommendation (22.2%-44.3%) and minimal-standard report completion (27.8%-40.8%). Template use also improved inpatient PPI administration and compliance (53.6%-73.6% and 71.7% vs. 63.4%, respectively), discharge PPI prescription (35.7%-54%) and follow-up EGD order (85.7% vs. 77.3%).
“Our project leveraged endoscopy software to standardize efficient provider documentation resulting in improved clinical care,” Yen said. “Our intervention required minimal implementation costs, low burden of maintenance and sustainability with high utilization rates over the course of 6 months. Similar endoscopy templates can be applied to other health systems and endoscopic procedures to improve the quality of care.”
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Yen T, et al. Optimizing endoscopy procedure documentation improves guideline adherent care in upper gastrointestinal bleeding. Presented at: ACG Annual Scientific Meeting; Oct. 22-27, 2021; Las Vegas (hybrid meeting).
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