Patient Education After Inadequate Bowel Preparation: Improving Care and Outcomes
Background: A colonoscopy is recommended for prevention and early detection of colorectal cancers. A high-quality bowel preparation is associated with adequate polyp detection and one of the colonoscopy preparation quality measures. However, many patients arrive for colonoscopy appointments with inadequate bowel preparation, and approximately 20% of patients with colonoscopy failure were not adherent to instructions. The purpose of this study was to determine whether using a questionnaire would improve the outcomes of patient education and proper bowel preparation.
Observations: Charts were reviewed to develop a patient questionnaire. A mix of open- and closed-ended, patient-centered questions were developed to further patient education in a time-efficient manner and achieve consistent responses for determining barriers and issues, improve documentation, and then assist the patient in achieving a good-to-excellent quality bowel preparation.
Conclusions: Proper cleansing instructions as well as identifying and overcoming barriers to achieving adequate bowel preparation for colonoscopy can result in improved patient satisfaction, care quality, and cost savings.
Within the VACHS, the result of inadequate colon preparation leads to either an aborted colonoscopy or a longer examination duration due to time spent washing the colon mucosa and then suctioning the liquified stool. Using newchoicehealth.com 2021 national data, the colonoscopy average price range was $1800 to $12,500; the national average amount paid is $2750.7 The average screening or diagnostic colonoscopy cost was $4469.8
Using the Colonoscopy Patient-Education Bowel Prep Questionnaire resulted in increased patient satisfaction, better use of current patient appointment slots, increased unique encounters, and direct and indirect fiscal savings. Patient satisfaction resulted from no additional repeat colonoscopies per patient’s statements. The other findings resulted from the reduction in repeat appointments: The appointment slots that would have been taken by repeat colonoscopies were available for new patients, resulting in an increase in unique encounters.
Fiscal savings resulted from avoiding the need for additional bowel preparations for those patients or using the GI staff time (nurses and clerks) to reschedule and educate patients. Prior to the use of the questionnaire, patients who failed preparations would be re-educated, given a new preparation prescription or mailed a new preparation, scheduled, and then mailed the appropriate paperwork, thus, increasing the workload for nurses and clerks.
Conclusions
Use of the questionnaire resulted in increased high-quality bowel preparation, an increase in the number of unique patients served, and improved efficiency. In addition, recovered appointment slots and modest reductions in additional purchases of preparation kits resulted in a potential cost savings for VACHS. Proper cleansing instructions as well as identifying and overcoming barriers to achieving adequate preparation for colonoscopy resulted in improved patient satisfaction, quality care, and cost savings.
Regardless of the type of colon preparation, addressing patient barriers to bowel preparation is translatable to other endoscopy facilities and practices that provide patient education within the VA.
