Predictors of post-colonoscopy emergency department use

Area of Science:

• Gastroenterology
• Health Services Research
• Quality Improvement

Background:

• Unplanned hospital visits within 7 days of colonoscopy are a proposed quality measure.
• Predictors of post-colonoscopy emergency department (ED) visits are not well understood.
• This study aimed to determine the incidence and predictors of ED visits within 7 days of colonoscopy.

Purpose of the Study:

• To identify patient, procedure, and endoscopist characteristics associated with post-colonoscopy ED visits.
• To determine the incidence and relatedness of ED visits within 7 days of colonoscopy.
• To inform quality improvement initiatives for reducing adverse events and healthcare costs.

Main Methods:

• Retrospective, single-center cohort study of outpatient colonoscopies.
• Evaluation of 50,319 colonoscopies performed between January 2008 and September 2013.
• Logistic regression analysis to identify independent predictors of ED use within 7 days.

Main Results:

• 0.76% of colonoscopies resulted in an ED visit within 7 days, with 68% related to the procedure.
• Predictors of ED visits included recent ED visit, electronic medical record (EMR) use, number of medication classes, endoscopist adenoma detection rate (ADR), and white race.
• Patient complexity, higher endoscopist ADR, and EMR were significantly associated with increased ED use.

Conclusions:

• Patient complexity, higher endoscopist ADR, and EMR are associated with increased post-colonoscopy ED visits.
• Identifying high-risk patients is crucial for targeted quality improvement efforts.
• These findings can help reduce adverse events and associated healthcare costs.