Successful applicants to the ASGE Endoscopy Unit Recognition Program submit a summary of a recently conducted quality improvement (QI) project as part of the application process. The quality assurance and performance improvement (QAPI) project in the spotlight this month looked at reversing an increasing number of cancelled colonoscopies due to inadequate bowel preparation and standardizing the use of the Boston Bowel Preparation Score (BBPS).
Define
Identification of increasing numbers of cancelled colonoscopies as a result of poor colon preparations. Several goals were developed to improve the colonoscopy cancellation rates through patient education, standardized tools and staff/provider education.
These goals included:
- Developing a tracking form to monitor the actual number of cancelled colonoscopies per month
- Standardizing use of the BBPS
- Educating providers on the use of the BBPS
- Revising patient education forms regarding preparation for a colonoscopy
- Monitoring cancelled colonoscopy rates following initiation of the varied approaches
Measure
To measure standardized use of the BBPS, I monitored the reports generated for each patient/procedure. The BBPS is documented manually on each colon report through our EMR. I educated/reinforced use of the scale and placed a hard copy of the BBPS at each provider’s computer as a visual reminder to include in each report.
A form was developed to track the number of colonoscopies cancelled daily. Staff were educated on the use of the form and the guidelines for completing the form. Baseline data related to colonoscopy cancellations was approximately five to six per month.
Analyze
Reinforcement to use the BBPS was successful. This also assisted in better identifying those patients who would need adjustments to the colon preparation for their future procedures.
Results were variable in relation to decreasing the number of cancelled colonoscopies. Each month showed a decrease in the cancellation number compared to the baseline; some months were more significant than others. The most recent data have shown an increase back to baseline. I attribute this to more consistent tracking with the addition of a unit coordinator.
Revision of the forms had taken a considerable amount of time to develop, approve and implement. These forms were simplified by lowering the reading level and increasing the conciseness of the forms. Pictures were also added to the forms for ease of reading.
Improve
Implementation of the BBPS and the revised forms occurred and are still in use. We are continuing to track the number of cancelled colonoscopies to assess the effectiveness of using the BBPS, longer-term use of the revised forms and the improved overall tracking.
Control
Barriers in achieving these goals were a lack of adequate tracking prior to the addition of a unit coordinator, as staff would forget to add to the tracking form. Another barrier was simply that patients did not read their instructions completely and correctly. As we continue to monitor the effects of the above measures, we are confident that patient satisfaction will be improved through a variety of ways, such as improving exam quality, decreasing patient risk for poor outcomes through extended procedure and anesthesia time, eliminating the need to reschedule, re-preparation and lost work income.
The financial aspect will also be improved for patients, insurance companies and our facility by eliminating prolonged procedures and rescheduling of procedures in a short period of time.
Staff and provider satisfaction will also be improved when not adding additional cases to the following day to accommodate cancelled cases. This will optimize time spent in each case by eliminating the need to spend large amounts of time flushing patients to attempt to complete the colonoscopy and ultimately cancelling.
We hope sharing this project summary will be useful to you and your practice. Learn more about gaining honoree status in the ASGE Endoscopy Unit Recognition Program. EURP honoree units may use the ASGE Quality Star logo in promotion of their units, receive premium educational content via an exclusive e-newsletter The Huddle, and enjoy a range of additional benefits. Questions should be directed to eurp@asge.org.