Sep 29, 2023, 11:04 by Sarah Moore

The organization reviewed the adequacy of the use of Brand A wipes in the contact cleaning of stretchers and procedure room surfaces between cases. The gap in quality of care that was discovered was that Clostridium difficile is not decontaminated by the chemical components in Brand A. The project goal is to find and use a product for wiping down stretchers and room surfaces that will adequately kill all the microorganisms that Brand A wipes handles and in addition covers Clostridium difficile which is a microorganism that is found in endoscopy patients.

Sep 29, 2023, 11:01 by Sarah Moore

The gap in quality of care that we studied is the lack of a standard recommended time for repeating a colonoscopy in patients who present for colon cancer screening but have inadequate bowel prep. We aimed to determine the incidence of adenomas detected in that population on the next colonoscopy and we attempted to define the optimum interval that should be recommended for a repeat colonoscopy in patient with inadequate bowel prep on their first examination.

Sep 29, 2023, 10:46 by Sarah Moore

This study will identify all procedures performed at the unit during a sample time period to calculate the average total patient wait time from the arrival/check in process at the front desk to the the performance of the procedure “Time Out” verification done in the procedure room prior to the start of anesthesia. The goal is to achieve a reasonable average total patient wait time of 60 minutes or less. This study will also identify areas in the patient’s procedure process where improvement can be made if the 60-minute goal is not met.

Sep 29, 2023, 10:36 by Sarah Moore

In the United States, it is estimated that more than 52,000 people will die of colorectal cancer in 2022, and roughly 151,000 new cases will be diagnosed; this makes colorectal cancer the second leading cause of cancer-related death and the fourth most diagnosed cancer site.

Sep 29, 2023, 10:32 by Sarah Moore

There is not a clearly defined process for follow-up in patients with a positive FIT ordered by primary care. Among patients with an abnormal FIT result, between 1 in 10 and 1 in 30 have colorectal cancer (CRC), and failure to complete a colonoscopy is associated with a higher risk of colorectal cancer death.

Sep 29, 2023, 10:28 by Sarah Moore

The surgery center's management and Quality Assurance (QA) Committee noticed a significant disparity in requests for pre-procedure blood thinner clearances (BTCs) for patients receiving anticoagulation therapy and responses (if any) from prescribing physicians. This gap would lead to frequent cancellation of procedures, as patients would not be able to be off anticoagulants for an appropriate amount of time or, in some instances, patients would take the initiative and “self-discontinue” critical medications without the recommendation of their physician. The center relied upon its sister medical practice and scheduling service up to this point to send BTCs to a patient’s prescribing physician with a generous lead time (at least 10 days) to receive a response. Our goal was to test-drive improvements in BTC tracking and follow-up and patient and physician communication in both the surgery center and scheduling department to reduce the amount of associated procedure cancellations due to not having received a response and the potential risk of delayed care.

Sep 29, 2023, 10:25 by Sarah Moore

Our newest improvement project was to eliminate the use of hot biopsy forceps for diminutive polyps. Over the years, the number of providers using this method has decreased; however, there were still a few using it. We had discussions with these physicians and showed them "Endoscopic Removal of Colorectal Lesions: Recommendations by the US Multi-Society Task Force on Colorectal Cancer." We encouraged them to switch from hot biopsy forceps to cold snare. From the beginning of 2022 to now, there has been no use of hot biopsy forceps polypectomies.

Sep 29, 2023, 10:22 by Sarah Moore

A gap was identified in quality of care around a safe exit from the building. The focus of our study surrounded optimal patient safety and satisfaction in relation to the discharge exit. The goal was that by the end of September there would be no more than one negative patient comment regarding unsafe exits from the building.

Sep 29, 2023, 10:13 by Sarah Moore

The practice has seen an increased percentage of “no-shows” across all physicians over the past several months. “No-show” means any patient who fails to arrive for a scheduled procedure appointment. No-shows create gaps and inefficiency in quality care, schedules and finances.

Sep 29, 2023, 10:07 by Sarah Moore

Appropriate scheduling of endoscopy patients in an ASC is critical in providing safe quality care. Rescheduling due to patient complexity is costly to the patients, families and ASC. Patients performed colon preparations, found transportation and took time off work. With limited resources that an ASC can offer, it is essential that the most appropriate care is provided to the most appropriate population.

Sep 29, 2023, 10:03 by Sarah Moore

This quality project aimed to improve adenoma detection rate (ADR) by integrating AI-assisted colonoscopy. Data from control and experimental groups showed a 38.46% increase in ADR, surpassing the 10–15% goal. No corrective action was needed; remeasurement is planned.

Sep 29, 2023, 10:00 by Sarah Moore

During physician peer review meetings in January 2021, physicians reported a significant increase in incomplete and aborted colonoscopies due to suboptimal bowel cleanses in the past three months. Colonoscopy remains the standard in colon cancer screening and prevention. Inadequate colon preparation could result in poor mucosal visibility, leading to low adenoma detection rates, which could result in an increase in adenocarcinomas. The purpose of this study was to increase the quality of bowel preparation.

Sep 29, 2023, 09:57 by Sarah Moore

Sep 28, 2023, 11:46 by Sarah Moore

It was observed by the endoscopy nurse manager that the endoscopy unit staff lacked general gastroenterology knowledge due to previously working in other medical fields, thus the gap in quality care was staff being unknowledgeable. Project goal was to have 90% increase in staff knowledge.

Sep 27, 2023, 14:14 by Sarah Moore

A 28-year-old female with a history of laparoscopic cholecystectomy one year ago presents to the GI clinic for follow-up of a possible “cyst on her liver.” At the time of her cholecystectomy, an ultrasound of the gallbladder and biliary tree was performed. She recalls her surgeon recommending follow-up with a gastroenterologist for further evaluation. She is asymptomatic. Recent labs by her primary physician include a normal complete blood count and comprehensive metabolic panel. She has no known personal or family history of liver disease. She denies risk factors for viral hepatitis. She consumes four to six alcoholic beverages per week. She has hypothyroid disease that is well controlled on once daily levothyroxine. She does not take any other medications, vitamins or herbal supplements.

Sep 27, 2023, 14:13 by Sarah Moore

A 48-year-old male with a medical history for hyperlipidemia and appendectomy several years ago presents to the emergency room (ER) with a chief complaint of nausea and vomiting. The nausea and vomiting began 12 hours ago. He has had multiple episodes of nonbloody emesis. He also describes crampy abdominal pain located around the “belly button” and inability to pass gas (flatus). His only medication is atorvastatin. Physical examination reveals abdominal distention, tympany on percussion and high-pitched “tinkling” sounds on auscultation. The ER advanced practice provider-physician team suspects an acute small bowel obstruction (SBO) secondary to adhesions from his appendectomy.

Sep 27, 2023, 14:13 by Sarah Moore

A 54-year-old male with a medical history of hypertension and GERD presents to the GI clinic with a chief complaint of dysphagia for six months. It is intermittent and only to solids, most commonly when eating beef or chicken. He estimates symptoms occur one to two times per month. This has remained stable over the last six months with no progression. He denies dysphagia to liquids or soft food. He has not lost weight. He denies nausea, vomiting, melena, hematemesis or coffee ground emesis. His GERD is well controlled by 20 mg daily of omeprazole taken orally 30 minutes prior to breakfast. His hypertension is well controlled by lisinopril. He does not take any other medications, including over-the-counter products or supplements. He has no history of asthma, seasonal allergies or food allergies. There is no known family history of gastrointestinal malignancy. Nine months ago, at his annual primary care evaluation, routine lab tests were completed, including complete blood count and comprehensive metabolic panels. Results were all within normal limits. His physical examination is unremarkable. Specifically, there was no evidence of lymphadenopathy, thyromegaly, or palpable masses or tenderness in the chest or abdomen during the examination.

Sep 27, 2023, 14:13 by Sarah Moore

A 54-year-old female with a medical history significant for GERD presents to the GI clinic with a chief complaint of diarrhea. It began six weeks ago. She has four to eight watery, non-bloody bowel movements per day. The diarrhea is associated with fecal urgency and occasional nocturnal diarrhea. She has not used antibiotics recently. She has had no recent travel outside the U.S. or no known ill contacts. She does not use magnesium containing antacids or supplements and denies any recent dietary changes. She does not report consumption of sugar-free candies or diet beverages. Her GERD is well controlled with lansoprazole 30 mg once daily prior to breakfast. Over-the-counter anti-diarrheal medications did not help.

Sep 27, 2023, 14:12 by Sarah Moore

A 56-year-old male with a past medical history significant for type 2 diabetes mellitus and hypertension presents to the GI clinic with a chief complaint of abdominal pain for four days. Pain is localized to the left lower quadrant. He describes it as sharp and variable in intensity. It does not radiate. He has not had a bowel movement in 48 hours. Typically, he has a bowel movement every day.

Sep 27, 2023, 14:12 by Sarah Moore

A 40-year-old woman presented for evaluation of dysphagia. Symptoms began three years ago and recently worsened. She has dysphagia to solids and liquids with almost every meal. She describes a sensation of “food or liquids stacking up in my esophagus.” Some episodes of dysphagia are associated with mild substernal chest pressure. She will walk around, raise her chin and move her shoulders backward in an attempt to alleviate the discomfort. She has rare episodes of nocturnal oral regurgitation, denies weight loss, GI bleeding and heartburn, and does not use alcohol or tobacco. She takes levothyroxine for hypothyroidism. There is no other medical history and no family history of GI cancers. She denies seasonal allergies.