Colon

4 - A Multidisciplinary Clinical Care Pathway Improves the Quality of Inpatient Colonoscopy Bowel Preparations

Monday, October 8
8:36 AM - 8:48 AM
Location: Terrace Ballroom (level 400)

Category: Colon
Alexandra Strauss, MD, MIE, Jennifer Yeh, MD, Janet Yoder, BSN, Diego Martinez, PhD, Lawrence Hsu, MS, Neysa Ernst, RN, MSN, Ravi Nehra, PharmD, Haithem Al-Grain, MD, Anne-Marie Lennon, MD, Christopher Fain, DO
Johns Hopkins Hospital, Baltimore, MD

Award: Fellows-in-Training Award (Colon Category)

Introduction: Effective colonoscopy is reliant on an adequate bowel preparation (BP). Poor BP can lead to delayed and repeated procedures and increased length of stay, complications and costs. Whereas the literature is robust in regards to best practices for outpatient BP, the literature is lacking for hospitalized patients. Inpatient BPs are often inadequate due to multiple factors including acute patient illness and the complexity of delivering BP in the hospital. The primary aim of our quality improvement project was to evaluate and improve the inpatient BP process in order to increase the percentage of adequate inpatient BP.

Methods: We performed a literature review to inform our evidence-based intervention and evaluated our current practices using health systems engineering process improvement methods, such as Ishikawa diagrams, process maps, and tracers. We identified key stakeholders to address the problem and formed a multi-disciplinary team which included: residents, fellows, gastroenterologists, floor and endoscopy nurses, anesthesiologists, and pharmacists. We utilized information technology (IT) in the form of ordersets and note templates to streamline communication between the GI, primary and nursing teams. We provided patient, nurse, and physician education in form of hands on training, verbal point-of-care information, and handouts. Pre- and post-intervention data was analyzed using interrupted time series and Kruskall-Wallis analysis.

Results: Based on literature review and process analysis, an inpatient BP protocol was developed by our multi-disciplinary committee. There were 121 and 129 patients in the pre- and post-intervention groups, respectively. Using interrupted time series analysis that controls for the individual and system level factors, there was an immediate increase in the percent of adequate BP between pre- and post-intervention groups (60.8 vs 79.3%, 95% CI 30.1 to 30.7, p-Value=0.0424). In the post-intervention period, there was strong evidence of sustained improvement. There was also an improvement in delayed cases and length of stay, but it was not statistically significant.

Discussion: Creating a successful clinical care pathway for inpatient colonoscopy BP can be done through a multidisciplinary effort, multifaceted education, and IT interventions. By addressing problems at patient, provider, and system levels, inpatient BPs can be significantly improved as demonstrated in this study.


Disclosures:
Alexandra Strauss indicated no relevant financial relationships.
Jennifer Yeh indicated no relevant financial relationships.
Janet Yoder indicated no relevant financial relationships.
Diego Martinez indicated no relevant financial relationships.
Lawrence Hsu indicated no relevant financial relationships.
Neysa Ernst indicated no relevant financial relationships.
Ravi Nehra indicated no relevant financial relationships.
Haithem Al-Grain indicated no relevant financial relationships.
Anne-Marie Lennon indicated no relevant financial relationships.
Christopher Fain indicated no relevant financial relationships.

Alexandra Strauss

Johns Hopkins Hospital
Baltimore, Maryland

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