Background The diagnostic accuracy of colonoscopy requires a perfect visualisation of the colonic mucosa, making bowel preparation a fundamental requisite of the procedure. Failure to adequately cleanse the bowel for colonoscopy results in an increase in costs and risks for patients, such as failed detection of neoplastic lesions, prolonged procedure duration and repetition of the examination. Due to recurrent failures observed in our hospital settings, a problem-solving approach was undertaken.
Purpose The aim of this study was to evaluate the quality of the pre-colonoscopy process of in- and outpatients (IOP) and identify potential dysfunctions.
Material and methods In a 411-bed general hospital performing on average 90 colonoscopies per month, the colonoscopy reports of IOP from 1 January to 31 March 2017 were analysed. The rating of bowel preparation quality was determined according to the Boston Bowel Preparation Scale (BBPS). The laxative treatments used and the therapeutic indications were also recorded. A multidisciplinary team (MT) composed of a gastroenterologist, pharmacist, anaesthetist, nurse, senior nurse, endoscopist, dietetician and nurse-assistant met regularly for 6 months to assess the process, identify failure factors, create value-added flow and propose solutions to improve it. To compare the two groups, Student’s t or X 2 tests were used for continuous or dichotomous variables, respectively.
Results Two hundred and ninety-seven colonoscopy reports corresponding to 284 patients were analysed (13 patients repeated the examination). Eighty patients (28%) experienced an inadequate bowel preparation (BBPS ≤6 or annotation on report). The most widely used laxative was polyethylene glycol. The number of failures was significantly higher among inpatients compared to outpatients (p<0.005) using PEG. The main dysfunctions identifed were: steps of the process not known by the healthcare professionnals, inadequate use of laxatives, uninformed patients, inappropriate prescription or diet regimen. The proposed solutions made by the MT were process re-engineering, use of alternative laxatives to improve patient acceptability and elaboration of an information leaflet to empower patients in the colonoscopy preparation.
Conclusion The multidisciplinary healthcare approach led to the identification of the dysfunctions of the pre-colonoscopy process and to the implementation of new practices that improved patient engagement. A new evaluation will be performed in 2018 and the target is to reduce failures by 30%.
No conflict of interest
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