ABSTRACT
DDW 2022 Author Disclosures: Basim Ali: NO financial relationship with a commercial interest ;Frederick Peng: NO financial relationship with a commercial interest ;Gyanprakash Ketwaroo: YES financial relationship with a commercial interest;AMBU:Consulting;CONMED:Consulting Introduction: The percentage of endoscopy cancellations are reported to range from 12% to 20% globally. Reducing same-day cancellations is a key tool in making an endoscopy unit more efficient and cost-effective. We aimed to use a quality- improvement (QI) model to reduce same day cancellations to less than 10% over two years. Methods: The study was carried out at the outpatient endoscopy unit at the Michael E. DeBakey Veteran Affairs Medical Center in Houston, Texas. All consecutive patients presenting for upper gastrointestinal endoscopy and/or surveillance colonoscopy from April 2018 to February 2020 were included in the study. The study was terminated after 22 months due to the COVID-19 pandemic and cancellation of all outpatient procedures. A fishbone diagram was created followed by a Pareto analysis in order to target interventions for the most common reasons for same-day cancellations. Two PDSA cycles were planned and implemented in the duration of the study. Results: Between April 2018 and December 2018, 7,075 endoscopy procedures were performed of which 805 were cancelled. The median number of cancellations were 12.9%. 608 (75.5%) of the procedure cancellations were related to either patients eating prior to the procedure (68.0%) or due to poor bowel preparation (9.1%;Figure 1). Two PDSA cycles were implemented in response to this information. The first PDSA cycle, implemented in May 2018, was the placement of a call seven days prior to the procedure with verbal instructions to patients about bowel preparation and a reminder about not eating breakfast on the morning of the procedure. No decrease in the number of cancellations was seen after the first PDSA cycle. A second PDSA cycle, implemented between March 2019 and June 2019, comprised of simplification of the language used in informational pamphlets mailed to patients and instituting a 24-hour automated telephone line to allow patients to confirm pre-procedure instructions. The median percentage of cancellations decreased from 12.9% pre-intervention to 11.0% post-intervention after the second PDSA cycle. There were no trends in the data collected and the number of runs (9) was within expected range for the number of useful observations (20). Although a preset reduction in percent cancellation of all procedures to less than 10% was not achieved a downward shift below the median was seen with the second intervention signifying a non-random decrease in cancellations (Figure 2). Conclusion: This study identified eating the day prior or on the day of endoscopy as the primary driver of same-day cancellations. Efforts to improve adherence to appropriate pre-procedure instructions are needed. In this QI project, simplifying the language of written information material and implementation of a 24-hour automated telephone line with pre-procedure instructions reduced same-day endoscopy cancellations. [Formula presented] Pareto analysis of reasons for same-day endoscopy cancellation from April 2018 to December 2018. [Formula presented] Monthly percentage cancellation of endoscopy procedures from April 2018 to February 2020. No data was collected during April and May 2019 due to planning of interventions. Revised pamphlets were mailed out starting March 2019 and the 24-hour call line was instituted June 2019.
ABSTRACT
Background: The Houston Veterans Affairs (VA) Medical Center is one of six VA liver transplant centers and has typically brought patients to Houston for evaluation and follow-up During the coronavirus 2019 (COVID-19) pandemic, VA Video Connect (VVC) - a VA-specific HIPAAcompliant video telehealth portal - was pilot-tested to provide remote and socially-distanced care for transplant patients We assessed VVC implementation by measuring patient and provider satisfaction Methods: Pilot implementation of VVC between March 13 & May 27, 2020 was based on model for improvement and Plan-Do-Study-Act (PDSA) frameworks Patients opted into VVC visits Providers were surveyed on overall satisfaction, technical difficulties, and missed crucial physical exam findings. Patients were surveyed on overall satisfaction, quality of interface, and self-report of time- and money-savings All satisfaction scores were assessed using a 5-point Likert scale (1= least satisfied, 5=most satisfied or 1=very easy, 5=very difficult). Demographic information was obtained via chart review Summary statistics were performed Results: There were 63 VVC liver transplant encounters with 2 providers. Technical difficulties occurred in 33 (53 2%) encounters, with 46 (74 2%) completed using VVC alone (8 1% switched to telephone;6 4% to other video modality) Average (standard deviation) provider satisfaction was 4 0 (1 2) No providers reported management would have changed if in-person physical exam were available Of 20 (32 3%) patients who responded to the telephone survey (95% male;average age 59 years), average patient satisfaction was 4 8 (0 7), quality of interface was 4 1 (1 3), and ease of technical set up was 1 6 (1 4] All patients would do a VVC visit again Overall, respondents lived a median of 219 miles away from the study site and reported a median time saving of 1 75 hours and median money saving of $50 Conclusion: Our pilot implementation demonstrated VVC encounters are feasible and acceptable to liver transplant patients and their providers We found substantial time and money savings for our patients Although this pilot occurred during restrictions of the COVID-19 pandemic, our findings hold promise to continue video visits beyond the pandemic and thus improve access to care for liver transplant patients who live far from transplant centers Notably, technical issues were common Further resources should be directed towards studying and improving video telehealth, especially among older populations.