ABSTRACT
BACKGROUND: Inpatient colonoscopy bowel preparation (ICBP) is frequently inadequate and can lead to adverse events, delayed or repeated procedures, and negative patient outcomes. Guidelines to overcome the complex factors in this setting are not well established. Our aims were to use health systems engineering principles to comprehensively evaluate the ICBP process, create an ICBP protocol, increase adequate ICBP, and decrease length of stay. Our goal was to provide adaptable tools for other institutions and procedural specialties. METHODS: Patients admitted to our tertiary care academic hospital that underwent inpatient colonoscopy between July 3, 2017 to June 8, 2018 were included. Our multi-disciplinary team created a protocol employing health systems engineering techniques (i.e., process mapping, cause-effect diagrams, and plan-do-study-act cycles). We collected demographic and colonoscopy data. Our outcome measures were adequate preparation and length of stay. We compared pre-intervention (120 ICBP) vs. post-intervention (129 ICBP) outcomes using generalized linear regression models. Our new ICBP protocol included: split-dose 6-L polyethylene glycol-electrolyte solution, a gastroenterology electronic note template, and an education plan for patients, nurses, and physicians. RESULTS: The percent of adequate ICBPs significantly increased with the intervention from 61% pre-intervention to 74% post-intervention (adjusted odds ratio of 1.87, p value = 0.023). The median length of stay decreased by approximately 25%, from 4 days pre-intervention to 3 days post-intervention (p value = 0.11). CONCLUSIONS: By addressing issues at patient, provider, and system levels with health systems engineering principles, we addressed patient safety and quality of care provided by improving rates of adequate ICBP.
Subject(s)
Gastroenterology , Inpatients , Cathartics , Colonoscopy , Humans , Patient-Centered Care , Polyethylene GlycolsABSTRACT
Therapeutic endoscopy is emerging as an innovating alternative to gastroenterology surgery. Due to the increase in new technologies, endoscopy clinical staff require ongoing education to develop safe, competent practice for new equipment and supplies. Maintaining competencies with new equipment and supplies can be challenging. This article illustrates the development and implementation of a continuous educational program for endoscopy clinical staff at a major academic medical center. An initial needs assessment of staff education and competency led to the multidisciplinary plan for continuous education. Development of the Nurse Product Procedure Group enabled endoscopy staff to standardize care and maintain competency in advanced therapeutic procedures. The Nurse Product Procedure Group offers various pathways of learning to meet clinical staff's individual learning needs. Over a 5-year span of implementation, staff satisfaction of education and resources improved. Key implementation elements of the Nurse Product Procedure Group include monthly staff education, resource development, multidisciplinary collaboration, cost savings, outreach education, and external collaboration with national and international gastroenterology professional organizations and societies.
