Improving Missed Follow-Up Colonoscopy Rate After Acute Diverticulitis: A Quality Improvement Project

Introduction: Acute diverticulitis (AD) is widespread worldwide and most prevalent in developed countries. The American Gastroenterological Association Institute recommends a colonoscopy for patients with AD within 6-8 weeks of AD if not performed within the past year to assess the extent of diverticular disease and to screen for colorectal cancer. The missed follow-up colonoscopy rate for AD patients at University Health between July 1, 2021, and June 30, 2022, was 99.2%. We aimed to reduce the missed follow-up colonoscopy rate after AD from 99.2% to less than 60%. Methods: The quality improvement interventions included the implementation of an EMR alert notification for patients with AD at discharge and Internal Medicine (IM) residents' education. The alert is triggered by the discharge order for patients with AD and requires the provider to choose between ordering a future GI clinic follow-up or outpatient colonoscopy (Figure 1A). Educational efforts included presentations at resident meetings and dissemination of infographics and handouts via email. The primary outcome was missed follow-up colonoscopy rate. Patients with ICD-10 codes for AD who are admitted to medicine, general surgery, or discharged from the emergency department were included. Patients who had undergone colonoscopy in the prior year were excluded. The number of alerts triggered and colonoscopies ordered were collected as process measures. The pre-intervention period was from November 2021 to March 2022, and the post-intervention was from November 2022 to March 2023. Results: Resident Education was delivered on 12/08/2022, and materials were disseminated 3 times. The missed follow-up colonoscopy rate in AD patients decreased from 98.4% during the pre-intervention period to 55.2% (P-value = 0.04) during the post-intervention timeline (Figure 1B). The alert was triggered 38 times. Four outpatient colonoscopy orders were placed, while 13 outpatient GI clinic orders were placed. Conclusion: Our interventions reduced missed follow-up colonoscopy rates in AD patients. The long-term implementation of these interventions will ultimately improve the quality of care for this cohort. This low-resource intervention could be replicated at other facilities. Our project limitations include short pre- and post-intervention periods, resulting in limited observation time. Also, some AD cases might have been missed if not documented via ICD-10 codes.Figure 1.: A: Alert notification when discharging patients with acute diverticulitis. B: Comparison of missed follow-up colonoscopy rates for patients with acute diverticulitis (pre-intervention vs post-intervention).