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Abstract 13 Voice of the Veteran Analysis: Implementation of a Revised Pathology Letter After Colonoscopy
August 2017 Abstract 13 Voice of the Veteran Analysis: Implementation of a Revised Pathology Letter After Colonoscopy Krista Edelman, Gabriel Mansouraty, Deborah Fisher, Ziad Gellad BACKGROUND & AIMS: The Veterans Health Administration
(VHA) Gastroenterology Program aims to provide highquality colonoscopies and timely communication of the procedure results. At our VA medical center, the previous colonoscopy pathology letters were brief and potentially unclear for patients unless significant information was manually added. Additionally, some veterans had voiced confusion regarding the implications and recommended follow-up outlined in the letters. The goals of this quality improvement (QI) project were to: (1) to measure baseline patient comprehension and satisfaction with the current colonoscopy pathology results letter, (2) to use Veteran and GI provider input to revise the letter, and (3) to measure patient comprehension and satisfaction with the revised letter. METHODS: We interviewed a random sample of 30 patients who had undergone either a screening or surveillance colonoscopy between January 2015–March 2015 using a standard list of questions (Table 1). Using patient responses, we revised the letter template. The revised template was distributed to GI faculty for further input. We then implemented the revised template and added an
AGA Section
593
automatic printing function. Finally, we interviewed a random sample of 30 patients who had undergone a colonoscopy between January 2016–February 2016 using the same script and questions as the first sample of patients. RESULTS: The survey results are listed in Table 1. Overall understanding improved with 30% fewer patients reporting lingering questions after receiving the pathology results letter. Patient understanding scores also improved. Additionally, there was a 6% increase in the number of patients who understood the recommended surveillance interval for their next colonoscopy after initiation of the revised template. Finally, the number of patients who received their pathology letter improved. CONCLUSIONS: Using a patientcentric approach to evaluating and improving the process of communicating results and recommendations after colonoscopy, we were able to increase patient satisfaction and understanding. We also detected and corrected errors in failing to print the letter for mailing, thereby reducing the number of patients who failed to receive a results letter. In the future, we hope to implement similar projects to improve the quality of our EGD pathology in regards to Barrett’s esophagus surveillance, gastric intestinal metaplasia, and Helicobacter pylori treatment. Conflicts of interest The authors disclose no conflicts.
Table 1. Old Template Did you receive your letter? Do you have questions after reading your letter/results? Do you understand the results of your colonoscopy? Do you understand the information about the types of polyps that you had? Do you know when your next colonoscopy is due? Did the letter come as a single page? Did you have any concerns about the quality of the letter?
Yes No Yes No 0-5 0-5 Yes No Yes No Yes No
26/30 4/30 15/30 15/30 3.9 3.5 26/30 4/30 28/30 2/30 7/30 23/30
% 87 13 50 50
87 13 93 7 23 77
New Template Yes No Yes No 0-5 0-5 Yes No Yes No Yes No
29/30 1/30 6/30 24/30 4.4 4.6 28/30 2/30 24/30 6/30 4/30 26/30
% Difference 97 3 20 80
93 7 80 20 13 87
þ10% -30% þ0.5 þ1.1 þ6% -13% -10%
(VHA) Gastroenterology Program aims to provide highquality colonoscopies and timely communication of the procedure results. At our VA medical center, the previous colonoscopy pathology letters were brief and potentially unclear for patients unless significant information was manually added. Additionally, some veterans had voiced confusion regarding the implications and recommended follow-up outlined in the letters. The goals of this quality improvement (QI) project were to: (1) to measure baseline patient comprehension and satisfaction with the current colonoscopy pathology results letter, (2) to use Veteran and GI provider input to revise the letter, and (3) to measure patient comprehension and satisfaction with the revised letter. METHODS: We interviewed a random sample of 30 patients who had undergone either a screening or surveillance colonoscopy between January 2015–March 2015 using a standard list of questions (Table 1). Using patient responses, we revised the letter template. The revised template was distributed to GI faculty for further input. We then implemented the revised template and added an
AGA Section
593
automatic printing function. Finally, we interviewed a random sample of 30 patients who had undergone a colonoscopy between January 2016–February 2016 using the same script and questions as the first sample of patients. RESULTS: The survey results are listed in Table 1. Overall understanding improved with 30% fewer patients reporting lingering questions after receiving the pathology results letter. Patient understanding scores also improved. Additionally, there was a 6% increase in the number of patients who understood the recommended surveillance interval for their next colonoscopy after initiation of the revised template. Finally, the number of patients who received their pathology letter improved. CONCLUSIONS: Using a patientcentric approach to evaluating and improving the process of communicating results and recommendations after colonoscopy, we were able to increase patient satisfaction and understanding. We also detected and corrected errors in failing to print the letter for mailing, thereby reducing the number of patients who failed to receive a results letter. In the future, we hope to implement similar projects to improve the quality of our EGD pathology in regards to Barrett’s esophagus surveillance, gastric intestinal metaplasia, and Helicobacter pylori treatment. Conflicts of interest The authors disclose no conflicts.
Table 1. Old Template Did you receive your letter? Do you have questions after reading your letter/results? Do you understand the results of your colonoscopy? Do you understand the information about the types of polyps that you had? Do you know when your next colonoscopy is due? Did the letter come as a single page? Did you have any concerns about the quality of the letter?
Yes No Yes No 0-5 0-5 Yes No Yes No Yes No
26/30 4/30 15/30 15/30 3.9 3.5 26/30 4/30 28/30 2/30 7/30 23/30
% 87 13 50 50
87 13 93 7 23 77
New Template Yes No Yes No 0-5 0-5 Yes No Yes No Yes No
29/30 1/30 6/30 24/30 4.4 4.6 28/30 2/30 24/30 6/30 4/30 26/30
% Difference 97 3 20 80
93 7 80 20 13 87
þ10% -30% þ0.5 þ1.1 þ6% -13% -10%