Single Center Evaluation Of Patient And Healthcare System Related Factors Influencing Inadequate Bowel Preparation Rates

INTRODUCTION: Colonoscopy is the most effective test for the detection and prevention of colorectal cancer. However, studies report 20 to 40 percent of colonoscopies have inadequate bowel preparation (IBP). Having high rates of IBP lead to challenges including those of quality, safety, economic and most notably, patient experience which have consequences that increase rate of aborted procedures, failure to reschedule, missed detection of polyps and cancer. Many institutions have a triage process to determine both patient and healthcare system related predictors contributing to poor rates. Understanding this, we dedicated efforts to identify the IBP rate in our center as well as factors that influence it. METHODS: Outpatient Colonoscopy procedure data were collected from Provation® and Athena® electronic medical records from December 31, 2018 to December 31, 2019. IBP is defined as presence of any form of stool that precludes visualization and require a repeat colonoscopy within a year. Patient factors included age, gender, if English is a primary language, presence or absence of more than 2 comorbidities, constipation, and Medicaid insurance. Healthcare system-related factors included procedures booked in private vs fellows clinic, morning vs afternoon procedure, month vs after a month, directly vs after consultant visit, and repeat procedures. RESULTS: A total of 1505 colonoscopies were performed and 175 (11.6%) had IBP. Of these, 42.3% were initial colonoscopies, 56.6% had prior colonoscopies performed and only 14.3% returned for repeat colonoscopy. IBP was seen in 62.9% of screening colonoscopies and 36.6% of diagnostic colonoscopies (Figure 1). The most common prep used was Golytely®. Healthcare system-related factors are displayed in Figure 2, and patient-related factors are displayed in Figure 3, respectively. CONCLUSION: Poor colonoscopy preparation is an ongoing issue that affects both the patient and healthcare system alike in many aspects. We sought to evaluate our centers colonoscopy preparation rates. There was no single patient related factor that contributed to significant IBP rate. However, within the system, procedures booked a month after the visit carried a high rate of poor preparation. This is likely due to the inherent memory recall issue, which our institution has now incorporated a patient phone call 48 hours in advance to explain preparation.Figure 1.: Indication for colonoscopy.Figure 2.: Healthcare system-related factors leading to inadequate bowel preparation.Figure 3.: Patient-related factors leading to inadequate bowel preparation.