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Content of Consent for Colonoscopy: Comparison of Patient-Reported Preferences, Physician-Reported Practices and Observed Practices
AGA Abstracts
informational booklet to supplement standardized consent does not seem to change patients' perceptions of those topics. Nonetheless, over half of patients found a booklet helpful.
401 CONTENT OF CONSENT FOR COLONOSCOPY: COMPARISON OF PATIENT-REPORTED PREFERENCES, PHYSICIAN-REPORTED PRACTICES AND OBSERVED PRACTICES David I. Fudman, Lilach Roemi, Katharine A. Germansky, Robert Gianotti, Daniel Leffler, Joseph D. Feuerstein Background: Little is known about physician and patient opinions and physician practices with regard to the content of consent for colonoscopy. We sought to measure these using 3 instruments: a survey of gastroenterologists (GIs), a survey of patients, and observations of actual consents. Methods: ASGE and CRICO (malpractice carrier) guidelines were used to develop a survey of GIs regarding the appropriate content of consent and their own consent practices. This was distributed to all GIs at a tertiary center. In addition, patients undergoing colonoscopy for a screening indication (including family history or history of polyps) were surveyed about their consent preferences. Lastly, we observed GIs consenting a separate population for colonoscopy for a screening indication. To assess compliance with performing a complete consent, ASGE guidelines were used to identify these necessary topics: the nature of the procedure, the reason for or benefits of the procedure, procedural risks, and risks of sedation. Results: 73% (n=34) of GIs responded to the survey. 32% (n= 11) were fellows. Patients were surveyed during their admission for colonoscopy and 100% (n=79) responded. Consents were observed in a separate cohort of 203 patients, and in 47% of cases a fellow was involved. (Table 1.) There was a high level of agreement among GIs about the necessity of discussing the nature of the procedure (100%), the reasons for/ benefits of the procedure (96%), procedural risks (100%) and alternatives to the procedure (89%). However, fewer GIs felt discussing the risks of moderate sedation was necessary (70%). On the same topics, patients had less agreement: 28% desired discussion of benefits/ reasons, 71% procedural risks, 19% alternatives and 33% sedative risks. (Table 2.) During observed consents, procedural risks and the reason for/benefits of colonoscopy were discussed in 99% and 98%. 75% were instructed on the nature of the procedure and 25% on risks of moderate sedation. Risks cited included bleeding (98% of patients), death (0.5%), infection (21%) and perforation (88%). (Table 2.) There were no significant differences between fellow and attending survey responses, but there was a trend toward attendings discussing infection more frequently (p=0.053). Only 20% percent of observed consents for patients receiving moderate sedation included all necessary components. Performing over 500 colonoscopies a year was predictive of an incomplete consent (OR 2.36, 95% CI 1.09-5.11, p= 0.03). Conclusions: In surveys of patients and GIs regarding the topics to be discussed in consent for colonoscopy, patients reported fewer topics of importance than GIs. When surveyed, GIs generally agreed on what should be covered, but in observed clinical practice these topics were discussed inconsistently. Future interventions are necessary to improve and standardize the consent process.
AGA Abstracts
402 TIMELINESS TO ANTIBIOTICS IN PEDIATRIC SHORT BOWEL SYNDROME PATIENTS WITH CENTRAL LINE AND FEVER IN THE EMERGENCY DEPARTMENT Erealda Prendaj, Daniel M. Fein, Nina M. Dadlez, John Thompson, Gitit Tomer Background: Short bowel syndrome (SBS) patients have a higher rate of central line associated bloodstream infection (CLABSI) than patients without intestinal failure (7.8 vs 1.3 per 1000 catheter days). SBS patients have a high incidence of gram-negative bacteremia, which is known to carry a high rate of morbidity and mortality. Prompt administration of antibiotics is crucial for successful management of patients with central line and fever. AIM: To decrease the time to antibiotics in SBS patients with central line and fever in the emergency department (ED) by 50 % by December of 2016. Methods: The setting was an academic ED at an urban quaternary center that sees ~60,000 children annually. We did a retrospective chart review of all SBS patients with central lines between April 2014 and July 2015, and collected demographics data, time to antibiotics when presenting to the ED with a fever, and blood culture results. In August 2015, we assembled a multidisciplinary quality improvement (QI) team, determined key drivers and intervention steps, and implemented changes to decrease the time to antibiotics in SBS patients with central line and fever in the ED. Interventions included education of ED staff, creation of "Fast Pass" wallet cards for families, creation of an EPIC© order set, and communication with pharmacy. Monthly average time to antibiotics was tracked and outcomes were presented using a run chart with pre-intervention and postintervention data. The median time to antibiotics in the pre and post-intervention periods was analyzed using a Wilcoxon Rank Sum Test. Results: In total, there were 51 admissions for fever in 12 SBS patients with central lines (19 admissions in the pre-intervention period, and 32 admissions in the post-intervention period). In the pre-intervention period, 32% of
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informational booklet to supplement standardized consent does not seem to change patients' perceptions of those topics. Nonetheless, over half of patients found a booklet helpful.
401 CONTENT OF CONSENT FOR COLONOSCOPY: COMPARISON OF PATIENT-REPORTED PREFERENCES, PHYSICIAN-REPORTED PRACTICES AND OBSERVED PRACTICES David I. Fudman, Lilach Roemi, Katharine A. Germansky, Robert Gianotti, Daniel Leffler, Joseph D. Feuerstein Background: Little is known about physician and patient opinions and physician practices with regard to the content of consent for colonoscopy. We sought to measure these using 3 instruments: a survey of gastroenterologists (GIs), a survey of patients, and observations of actual consents. Methods: ASGE and CRICO (malpractice carrier) guidelines were used to develop a survey of GIs regarding the appropriate content of consent and their own consent practices. This was distributed to all GIs at a tertiary center. In addition, patients undergoing colonoscopy for a screening indication (including family history or history of polyps) were surveyed about their consent preferences. Lastly, we observed GIs consenting a separate population for colonoscopy for a screening indication. To assess compliance with performing a complete consent, ASGE guidelines were used to identify these necessary topics: the nature of the procedure, the reason for or benefits of the procedure, procedural risks, and risks of sedation. Results: 73% (n=34) of GIs responded to the survey. 32% (n= 11) were fellows. Patients were surveyed during their admission for colonoscopy and 100% (n=79) responded. Consents were observed in a separate cohort of 203 patients, and in 47% of cases a fellow was involved. (Table 1.) There was a high level of agreement among GIs about the necessity of discussing the nature of the procedure (100%), the reasons for/ benefits of the procedure (96%), procedural risks (100%) and alternatives to the procedure (89%). However, fewer GIs felt discussing the risks of moderate sedation was necessary (70%). On the same topics, patients had less agreement: 28% desired discussion of benefits/ reasons, 71% procedural risks, 19% alternatives and 33% sedative risks. (Table 2.) During observed consents, procedural risks and the reason for/benefits of colonoscopy were discussed in 99% and 98%. 75% were instructed on the nature of the procedure and 25% on risks of moderate sedation. Risks cited included bleeding (98% of patients), death (0.5%), infection (21%) and perforation (88%). (Table 2.) There were no significant differences between fellow and attending survey responses, but there was a trend toward attendings discussing infection more frequently (p=0.053). Only 20% percent of observed consents for patients receiving moderate sedation included all necessary components. Performing over 500 colonoscopies a year was predictive of an incomplete consent (OR 2.36, 95% CI 1.09-5.11, p= 0.03). Conclusions: In surveys of patients and GIs regarding the topics to be discussed in consent for colonoscopy, patients reported fewer topics of importance than GIs. When surveyed, GIs generally agreed on what should be covered, but in observed clinical practice these topics were discussed inconsistently. Future interventions are necessary to improve and standardize the consent process.
AGA Abstracts
402 TIMELINESS TO ANTIBIOTICS IN PEDIATRIC SHORT BOWEL SYNDROME PATIENTS WITH CENTRAL LINE AND FEVER IN THE EMERGENCY DEPARTMENT Erealda Prendaj, Daniel M. Fein, Nina M. Dadlez, John Thompson, Gitit Tomer Background: Short bowel syndrome (SBS) patients have a higher rate of central line associated bloodstream infection (CLABSI) than patients without intestinal failure (7.8 vs 1.3 per 1000 catheter days). SBS patients have a high incidence of gram-negative bacteremia, which is known to carry a high rate of morbidity and mortality. Prompt administration of antibiotics is crucial for successful management of patients with central line and fever. AIM: To decrease the time to antibiotics in SBS patients with central line and fever in the emergency department (ED) by 50 % by December of 2016. Methods: The setting was an academic ED at an urban quaternary center that sees ~60,000 children annually. We did a retrospective chart review of all SBS patients with central lines between April 2014 and July 2015, and collected demographics data, time to antibiotics when presenting to the ED with a fever, and blood culture results. In August 2015, we assembled a multidisciplinary quality improvement (QI) team, determined key drivers and intervention steps, and implemented changes to decrease the time to antibiotics in SBS patients with central line and fever in the ED. Interventions included education of ED staff, creation of "Fast Pass" wallet cards for families, creation of an EPIC© order set, and communication with pharmacy. Monthly average time to antibiotics was tracked and outcomes were presented using a run chart with pre-intervention and postintervention data. The median time to antibiotics in the pre and post-intervention periods was analyzed using a Wilcoxon Rank Sum Test. Results: In total, there were 51 admissions for fever in 12 SBS patients with central lines (19 admissions in the pre-intervention period, and 32 admissions in the post-intervention period). In the pre-intervention period, 32% of
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