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S Haimanot, L Hookey, W Paterson

Queen's University, Kingston, ON
Previous studies have documented problems with successful completion of colonoscopy in inpatients versus outpatients, but the reasons for this are not fully understood. The purpose of the current study was to determine the reasons for cancellation of inpatient colonoscopy to provide a basis for implementing interventions to decrease cancellation rates.
METHODS: We conducted a retrospective chart review of all colonoscopy procedures conducted on inpatients at the Kingston General Hospital between January 1st 2009 and August 31st 2009 to identify all patients who had their colonoscopy cancelled and rescheduled. Patients who had unsuccessful colonoscopy for technical reasons or patient discomfort were not considered as cancellation cases.
For all other cases, the reason(s) for the cancellation were characterized.
RESULTS: Overall, 237 colonoscopies on 206 patients were scheduled during the 9 month period. Of these, 16.9% (40 cases) were cancelled. 16 (40%) were cancelled prior to the procedure, 9 (22.5%) on arrival in the endoscopy unit and 15 (37.5%) during the procedure. The reason for cancellation included failure to give the preparation in 3 patients (7.5%), refusal to take the preparation in 8 (20%), inability to complete the preparation in 7 (17.5%), poor results of preparation in 10 (25%) and unstable medical condition in 7 (17.5%). Consent was withdrawn in 3 patients (7.5%) and reason for cancellation could not be determined in 2 (5%). In 19 of 40 patients (47.5%), cancellation was deemed avoidable.
CONCLUSIONS: The high cancellation rate of inpatient colonoscopy at our centre (~17%) largely relates to bowel preparation problems, and close to half of cancelled cases should be avoidable. This study provides a basis for an intervention program to decrease inpatient colonoscopy cancellation rates and reduce hospital length of stay and associated costs.