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CAN PATIENT EDUCATION IMPROVE THE QUALITY OF INPATIENT BOWEL PREPARATION FOR COLONOSCOPY
D Krygier, R Enns, B Bressler
University of British Columbia, Vancouver, British Columbia
Aims: Lack of patient education is one of several factors that contribute to the reduced quality of bowel preparation seen in inpatients as compared to outpatients. Adequate bowel preparation is critical to maximize yield and minimize repeated procedures. We sought to determine whether enhanced education of inpatients prior to colonoscopy could improve the quality of bowel preparation and the yield of the procedure.
Methods: For 4 consecutive weeks, inpatients with any indication for colonoscopy received routine instructions with 4-litres of Go-lytely and a clear fluid diet the day prior to colonoscopy. Subsequently, for an additional 4 weeks, inpatients with similar indications for colonoscopy received a 5-minute counseling session on the day prior to colonoscopy to discuss the importance of the bowel preparation, how it should be taken and why. Written information was provided to reinforce key points. At the time of colonoscopy the quality of bowel preparation was assessed using a standardized scoring system that assigns a score from 0-4, as shown in table 1 (below). A total of 25 patients in each group is planned in this ongoing study, we report the interim results.
Results: 17 inpatients underwent colonoscopy with routine preparation and 6 underwent colonoscopy after the counseling session, thus far. Among those who received standard care the indications for colonoscopy were hematochezia (9), abdominal pain (4), iron deficiency anemia (2), diarrhea (1) and Streptococcus bovis bacteremia (1). Among those who received the counseling session the indications were a colorectal abnormality seen on imaging (2), occult GI bleeding (2), hematochezia (1) and abdominal pain (1). The median bowel preparation score for the patients who received standard care was 3 (range: 0-4), while for those who received the education session the median score was 2 (range: 1-3)(P=0.17). Significant pathology requiring intervention was found in 71% of patients (polyps in 5, inflammation in 5, adenocarcinoma in 1 and active bleeding in 1) who received standard care and 67% of patients (inflammation in 3 and adenocarcinoma in 1) who received the counseling session.
Conclusions: This study suggests that a short counseling session and written instructions can improve the quality of bowel preparation for inpatients undergoing a colonoscopy. If further data supports this conclusion, changes will be recommended to maximize the preparation quality through a short educational discussion with the patient.
Table 1
Cleanliness Quality Score