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Improving Adherence to Screening Colonoscopy Preparation and Appointments: A Multicomponent Quality Improvement

Eve Kalayjian1, Diane Bringman, Angel Naughton

  • 1Eve Kalayjian, BSN, RN, is Clinical Nurse, MetroHealth Medical Center, Cleveland, Ohio. Diane Bringman, BSN, RN, CGRN, is Clinical Nurse, MetroHealth Medical Center, Cleveland, Ohio. Angel Naughton, BSN, RN, is Nurse Manager, Ambulatory and Perioperative Services, MetroHealth Medical Center, Cleveland, Ohio. Sheila Bond, BSN, RN, is Clinical Nurse, MetroHealth Medical Center, Cleveland, Ohio. Wendy Sarver, MSN, RN, is Coordinator, Nursing Research, MetroHealth Medical Center, Cleveland, Ohio. Lorraine C. Mion, PhD, RN, FAAN, is Independence Foundation Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee.

Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates
|December 3, 2015
PubMed
Summary

Colorectal cancer screening via colonoscopy shows high no-show rates. Interventions improved attendance but increased cancellations due to poor preparation, requiring ongoing quality improvement.

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Area of Science:

  • Gastroenterology
  • Public Health
  • Healthcare Management

Background:

  • Colorectal cancer screening by colonoscopy is recommended for adults aged 50 and older.
  • Scheduling endoscopic procedures requires balancing multiple logistical factors, including physician availability, room resources, patient preparation, and staffing.
  • Patient nonattendance and inadequate preparation for colonoscopies lead to significant inefficiencies, resource waste, and increased healthcare costs, with reported nonattendance rates between 21% and 29%.

Purpose of the Study:

  • To investigate patient factors associated with nonattendance for colorectal cancer screening via colonoscopy.
  • To implement and evaluate quality improvement initiatives aimed at reducing both nonattendance and cancellations due to poor preparation for colonoscopies.

Main Methods:

  • A retrospective case-control study was conducted to identify patient factors linked to nonattendance.
  • Initial interventions focused on enhanced nurse-led follow-up and patient education for screening colonoscopies.
  • An interdisciplinary, interdepartmental quality improvement program was established to address system, nurse, and patient-specific factors influencing nonattendance and preparation-related cancellations.

Main Results:

  • Younger age (under 60 years), the type of appointment (screening vs. diagnostic), and insurance status were identified as factors associated with nonattendance.
  • Initial nurse-led interventions successfully improved attendance rates.
  • However, improvements in attendance were accompanied by an increase in cancellations attributed to poor patient preparation.

Conclusions:

  • Patient-specific factors, such as age and insurance, influence colonoscopy attendance.
  • Addressing nonattendance requires targeted strategies, but these can inadvertently increase cancellations if preparation issues are not simultaneously managed.
  • Ongoing, comprehensive quality improvement efforts involving multiple departments are crucial for optimizing colonoscopy scheduling efficiency and reducing resource waste.