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Patient Perception of Bowel Preparation for Colonoscopy in the Urban Tertiary Care Setting
July 2016
cause, in-hospital mortality was 6.5%. Length of stay was 5.7 days in the 2LBIV group vs 5.6 days. No patients in the 2LBIV group required transfer to a higher level of care vs 22% (7 of 31). However, 44% (4 of 9) of patients with 2LBIV were admitted directly to the intensive care unit vs 14% (5 of 36). The 2LBIV group received more blood transfusions (1.89 vs 1.56 U packed red blood cells/patient). Drop in hemoglobin from baseline was 1.7 g/dL in the 2LBIV group compared with 0.8 g/dL. Patients with 2LBIV had a higher rate of anticoagulant/antiplatelet use (44% vs 19%), lower initial systolic blood pressure (114 mm Hg vs 131 mm Hg) and lower initial creatinine level (0.73 mg/dL vs 1.44 mg/dL). CONCLUSIONS: The relatively simple and cheap intervention of placing 2LBIV lines is often not executed. Our investigation suggests that only sicker GIB patients receive 2LBIV. A process map of IV access in GIB has been developed, and areas for intervention have been identified. The next step will be to implement protocolized care for GIB patients, including 2LBIV, and re-examine adherence and patient outcomes. We suggest that specific mention of 2LBIV placement in guidelines from national societies like the American Gastroenterology Association might improve compliance in this aspect.
AGA Section
197
inadequate bowel preparation (BBPS <6). A majority of patients endorsed understanding the reason for colonoscopy (84%), the means of bowel preparation (79%), and the relationship of screening colonoscopy to overall health (83%). There was no association between demographic factors or patient perception with adequacy of bowel preparation. Interestingly, there was no association between patients’ assessment of bowel preparation success and an adequate BBPS score (P ¼ .63). A majority of patients felt the bowel preparation was annoying (53%), but most patients did not feel bowel preparation was painful, embarrassing, difficult, or dangerous (Figure 1). CONCLUSIONS: The perception of bowel preparation for colonoscopy is predominantly positive, and most patients report being able to follow instructions for bowel preparation. However, a significant number of outpatient colonoscopies are still hampered by poor preparation. Efforts should be taken to educate patients with multimodal instructional tools to improve understanding of successful bowel preparation.
Conflicts of interest The authors disclose no conflicts.
Patient Perception of Bowel Preparation for Colonoscopy in the Urban Tertiary Care Setting George K. John, Nitin K. Ahuja, Abhishek Agnihotri, Isabelita Ortiz, Mary Beth Carlin, and Ellen Stein Johns Hopkins Medical Institutions, Baltimore, Maryland BACKGROUND & AIMS: Inadequate bowel preparation ham-
pers visualization during colonoscopy, leading to missed lesions and the need to repeat screening colonoscopy. Patient perceptions and motivations can influence the quality of the bowel preparation as well as the likelihood of completing it. METHODS: We performed a cross-sectional study of all patients undergoing outpatient colonoscopy at Johns Hopkins Bayview Medical Center in Baltimore, MD, between October 2015 and November 2015. A written questionnaire documenting demographic data, educational status, living situation, and bowel preparation experience was administered during check-in at the endoscopy unit. Boston Bowel Preparation Score (BBPS), as determined by the patient’s endoscopist, was retrospectively collected from the electronic medical record. A BBPS score 6 was considered adequate for colorectal cancer screening purposes. Binary logistic regression was performed to assess the relationship between patient perception as well as demographic factors with adequacy of bowel preparation. RESULTS: A total of 58 patients underwent outpatient colonoscopy within the study interval. The mean age was 58 years (range, 2881 years) and the majority of patients were women (57%), white (62%), with a college degree or higher (62%). The majority of patients reported being able to complete the bowel preparation prescribed to them (88%). Most patients received written instructions by mail (95%), and the majority (60%) also received a phone call regarding bowel preparation. Only 14% of patients sought out additional information regarding colonoscopy preparation. The median BBPS was 6.0, with 35% of patients graded with an
Figure 1. Patient perception of bowel preparation for colonoscopy Conflicts of interest The authors disclose no conflicts.
“Skip the Drips”: An Initiative to Promote the Appropriate Use of Proton Pump Inhibitors in Patients With Upper Gastrointestinal Bleeding Emmanuel Coronel,1 Nikhil Bassi,2 Ellen Byrne,2 Sarah Sokol,2 Vineet Arora,2 K. Gautham Reddy1 1 Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, Illinois; and 2Department of Internal Medicine, University of Chicago Medicine, Chicago, Illinois BACKGROUND & AIMS: Proton pump inhibitors (PPIs) are part
of the standard of therapy in patients with upper gastrointestinal bleeding. The American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE) recommend PPI use. In the pre-endoscopy setting, PPIs decrease rates of high-risk stigmata found on endoscopy and the need for endoscopic therapy. In the postendoscopy setting, PPIs via continuous infusion (PPI drip) for 72 hours in patients who have ulcers with high-risk stigmata reduce the rates of rebleeding, surgery, and mortality. From our experience, and by looking at general pharmacy data, we
cause, in-hospital mortality was 6.5%. Length of stay was 5.7 days in the 2LBIV group vs 5.6 days. No patients in the 2LBIV group required transfer to a higher level of care vs 22% (7 of 31). However, 44% (4 of 9) of patients with 2LBIV were admitted directly to the intensive care unit vs 14% (5 of 36). The 2LBIV group received more blood transfusions (1.89 vs 1.56 U packed red blood cells/patient). Drop in hemoglobin from baseline was 1.7 g/dL in the 2LBIV group compared with 0.8 g/dL. Patients with 2LBIV had a higher rate of anticoagulant/antiplatelet use (44% vs 19%), lower initial systolic blood pressure (114 mm Hg vs 131 mm Hg) and lower initial creatinine level (0.73 mg/dL vs 1.44 mg/dL). CONCLUSIONS: The relatively simple and cheap intervention of placing 2LBIV lines is often not executed. Our investigation suggests that only sicker GIB patients receive 2LBIV. A process map of IV access in GIB has been developed, and areas for intervention have been identified. The next step will be to implement protocolized care for GIB patients, including 2LBIV, and re-examine adherence and patient outcomes. We suggest that specific mention of 2LBIV placement in guidelines from national societies like the American Gastroenterology Association might improve compliance in this aspect.
AGA Section
197
inadequate bowel preparation (BBPS <6). A majority of patients endorsed understanding the reason for colonoscopy (84%), the means of bowel preparation (79%), and the relationship of screening colonoscopy to overall health (83%). There was no association between demographic factors or patient perception with adequacy of bowel preparation. Interestingly, there was no association between patients’ assessment of bowel preparation success and an adequate BBPS score (P ¼ .63). A majority of patients felt the bowel preparation was annoying (53%), but most patients did not feel bowel preparation was painful, embarrassing, difficult, or dangerous (Figure 1). CONCLUSIONS: The perception of bowel preparation for colonoscopy is predominantly positive, and most patients report being able to follow instructions for bowel preparation. However, a significant number of outpatient colonoscopies are still hampered by poor preparation. Efforts should be taken to educate patients with multimodal instructional tools to improve understanding of successful bowel preparation.
Conflicts of interest The authors disclose no conflicts.
Patient Perception of Bowel Preparation for Colonoscopy in the Urban Tertiary Care Setting George K. John, Nitin K. Ahuja, Abhishek Agnihotri, Isabelita Ortiz, Mary Beth Carlin, and Ellen Stein Johns Hopkins Medical Institutions, Baltimore, Maryland BACKGROUND & AIMS: Inadequate bowel preparation ham-
pers visualization during colonoscopy, leading to missed lesions and the need to repeat screening colonoscopy. Patient perceptions and motivations can influence the quality of the bowel preparation as well as the likelihood of completing it. METHODS: We performed a cross-sectional study of all patients undergoing outpatient colonoscopy at Johns Hopkins Bayview Medical Center in Baltimore, MD, between October 2015 and November 2015. A written questionnaire documenting demographic data, educational status, living situation, and bowel preparation experience was administered during check-in at the endoscopy unit. Boston Bowel Preparation Score (BBPS), as determined by the patient’s endoscopist, was retrospectively collected from the electronic medical record. A BBPS score 6 was considered adequate for colorectal cancer screening purposes. Binary logistic regression was performed to assess the relationship between patient perception as well as demographic factors with adequacy of bowel preparation. RESULTS: A total of 58 patients underwent outpatient colonoscopy within the study interval. The mean age was 58 years (range, 2881 years) and the majority of patients were women (57%), white (62%), with a college degree or higher (62%). The majority of patients reported being able to complete the bowel preparation prescribed to them (88%). Most patients received written instructions by mail (95%), and the majority (60%) also received a phone call regarding bowel preparation. Only 14% of patients sought out additional information regarding colonoscopy preparation. The median BBPS was 6.0, with 35% of patients graded with an
Figure 1. Patient perception of bowel preparation for colonoscopy Conflicts of interest The authors disclose no conflicts.
“Skip the Drips”: An Initiative to Promote the Appropriate Use of Proton Pump Inhibitors in Patients With Upper Gastrointestinal Bleeding Emmanuel Coronel,1 Nikhil Bassi,2 Ellen Byrne,2 Sarah Sokol,2 Vineet Arora,2 K. Gautham Reddy1 1 Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, Illinois; and 2Department of Internal Medicine, University of Chicago Medicine, Chicago, Illinois BACKGROUND & AIMS: Proton pump inhibitors (PPIs) are part
of the standard of therapy in patients with upper gastrointestinal bleeding. The American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE) recommend PPI use. In the pre-endoscopy setting, PPIs decrease rates of high-risk stigmata found on endoscopy and the need for endoscopic therapy. In the postendoscopy setting, PPIs via continuous infusion (PPI drip) for 72 hours in patients who have ulcers with high-risk stigmata reduce the rates of rebleeding, surgery, and mortality. From our experience, and by looking at general pharmacy data, we