Penn State University Milton S. Hershey Medical Center Hershey, PA
Jessica Dahmus, MD1, Courtney Lester, BS2, Jennifer Maranki, MD1; 1Penn State University Milton S. Hershey Medical Center, Hershey, PA; 2Penn State University, Hershey, PA
Introduction: Colorectal cancer is the third most common cause of cancer-related death in the United States. Colonoscopy remains the optimal modality for detection and removal of precancerous lesions. Satisfactory bowel preparation remains an important component of polyp detection, removal, and safety. Unfortunately, 20-25% of all colonoscopies are reported to have unsatisfactory bowel prep. Multiple studies have shown that pre-endoscopy phone calls improve prep scores. However, these calls are typically 1-2 days prior to colonoscopy, possibly inducing sample bias with improved cleanliness scores due to pre-procedural drop-out. Additionally, many studies follow strict scripts that may not be feasible to reproduce in a real-world setting. This study aimed to evaluate the change in bowel cleanliness utilizing a nurse-driven phone call made two weeks prior to general colonoscopy. Methods: Retrospective chart analysis of patients undergoing colonoscopy in general endoscopy rooms at random two-week intervals prior to and after the quality improvement (QI) initiative was performed. Primary aim was to evaluate change in endoscopist-perceived bowel cleanliness score (rated on a 1-5 scale (1=unsatisfactory to 5=excellent)). Secondary aim evaluated whether type of phone call (direct conversation versus voicemail (VM)) affected bowel cleanliness scoring. Two sample independent t-test and chi-square analysis evaluated groups. Results: 218 patients (56.4% female) with mean age (55 +/- 16 years) were evaluated before and after QI implementation. Baseline characteristics (age, sex, weight, BMI, need for extended prep) were similar between cohort/call (n=70) and control/no call (n=148) groups. Of those who received a phone call, 36 (51.4%) were spoken to directly, while 34 (48.6%) received a VM. Mean prep quality was similar between cohort and control groups (2.97+/-1.04 vs. 3.18+/-1.15, p=0.21). Similarly, there was no significant difference in prep quality between phone call groups. Discussion: Implementing an unscripted phone call two weeks prior to colonoscopy did not appear to improve bowel cleanliness. Additionally, there did not appear to be a difference between bowel cleanliness when calls consisted of direct conversation versus VM. Less strict interventions implemented at a longer interval prior to colonoscopy may not be as beneficial as those closer to scheduled endoscopy. Further research will evaluate whether it is the interval versus the type of information provided that most influences bowel cleanliness.
Table 1. Patient characteristics in control and cohort group. Prep quality scale (1=poor/unsatisfactory, 2=fair, 3=adequate to identify polyps, 4=good, 5=excellent)
Table 2. Differences in perceived bowel preparation score between different types of phone calls.
Disclosures: Jessica Dahmus indicated no relevant financial relationships. Courtney Lester indicated no relevant financial relationships. Jennifer Maranki: Boston Scientific – Consultant.