Naemat Sandhu, MBBS1, Krysta John-Keating, MD1, Alison Platt, DO1, Christine Wambold1, Eric Barash2, Victor J. Navarro, MD, MHCM3
1Einstein Medical Center, Philadelphia, PA; 2Wake Forest University School of Medicine, Winston-Salem, NC; 3Thomas Jefferson University School of Medicine, Philadelphia, PA
Introduction: Non-emergent gastrointestinal (GI) procedures performed on inpatients increase costs in a diagnosis related group (DRG) reimbursement system. They prolong periods of inanition due to preps, interrupt patient rest and disrupt the flow of outpatient procedures. This study involved delivery of an educational intervention for gastroenterologists intended to reduce the number of non-emergent inpatient GI procedures at Einstein Medical Center Philadelphia.
Methods: The baseline rate of non-emergent inpatient GI procedure performance was determined for a 6-week period in 2018. Potential barriers contributing to performance of non-emergent inpatient GI procedures were assessed via a survey of twenty gastroenterologists. Total inpatient esophagogastroduodenoscopies (EGDs) and colonoscopies was collected, non-emergent procedures were identified during a 6-week pre-intervention phase A 30 minute didactic to brief all twenty on the American College of Gastroenterology guidelines on emergent GI procedure indications was delivered as the intervention. Post-intervention data was collected for total and non-emergent inpatient GI procedure performance for a 6-week period immediately following the intervention.
Results: Fear of patients not following up followed by fear of litigation were the most common reasons that caused providers to perform non-emergent inpatient GI procedures (fig.1). The rate of non-emergent EGDs and colonoscopies dropped from baseline to post-intervention periods; 31% to 8% (fig.2), and 49% to 20% (fig.3) respectively. The rate of non-emergent EGDs dropped further from pre to post-intervention, but rose slightly for colonoscopies.
Discussion: The process of measuring non-emergent GI procedure performance led to a reduction in utilization (Hawthorne effect), in keeping with guidelines. An educational intervention led to a further reduction in inpatient EGD utilization. Implementing steps to eliminate potential barriers may improve non-emergent inpatient GI procedure performance rates.
Citation: Naemat Sandhu, MBBS; Krysta John-Keating, MD; Alison Platt, DO; Christine Wambold; Eric Barash; Victor J. Navarro, MD, MHCM. P0370 - REDUCTION OF INPATIENT NON-EMERGENT GI PROCEDURE UTILIZATION. Program No. P0370. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.