An Automated Inpatient Split-dose Bowel Preparation System Improves Colonoscopy Quality and Reduces Repeat Procedures

Abstract

Our interdisciplinary initiative targeting inpatient colonoscopy preparations significantly improved quality and reduced repeat procedures, and hospital days. Other institutions should consider utilizing this framework to improve inpatient colonoscopy value.

Strategies to Improve Inpatients’ Quality of Bowel Preparation for Colonoscopy: A Systematic Review and Meta-Analysis

“…The detailed selection process is depicted on Figure 1. Eight randomized controlled trials (RCT) [15, 17, 19–21, 23, 26, 27] and nine observational cohort studies [11–14, 16, 18, 22, 24, 25] were available for analysis. In this systematic review, we classified included studies per intervention used for improving bowel cleanliness as follows: (1) education of patients and/or personnel regarding bowel preparation [11–16], (2) modification of preparation regimens [17–26], and (3) other interventions [27].…”

“…Table 1 illustrates the main characteristics of the included studies, published between 2003 and 2018, enrolling 2733 inpatients. All but one [20] were monocentric; fourteen [11–13, 15–17, 19–23, 25–27] and 3 [14, 18, 24] were prospective and retrospective studies, respectively. Among the prospective studies, 8 [13, 15, 17, 19–21, 23, 26] randomized participants in 2 groups (intervention vs. control).…”

“…Among the prospective studies, 8 [13, 15, 17, 19–21, 23, 26] randomized participants in 2 groups (intervention vs. control). The majority of the studies (11/17) took place in North and South America [12, 14–16, 18, 19, 21, 22, 24, 25, 27], while four studies were conducted in Europe [11, 17, 20, 26] and two in Asia [13, 23]. One retrospective case series [24] did not provide control arm and therefore was only used to measure the overall adequacy rate.…”

“…A variety of different bowel preparation scales was used to evaluate cleanliness. The OBPS [6] was used in 4 [13, 21, 23, 27] and the BBPS [28] in 3 [15, 22, 26], while both the BBPS and Aronchik Scale [28, 29] were used in 2 studies [24, 25]. One study [19] used the Chilton Scale [30], while the rest (7) [11, 12, 14, 16–18, 20] used miscellaneous rating scores, consisting of 3- to 6-point scoring scales (Supplemental Material C, Table 1).…”

Modifiable Factors Associated with Quality of Bowel Preparation Among Hospitalized Patients Undergoing Colonoscopy

“…17 In a quasi-experimental design, Yadlapati et al found that an automated split-dose bowel preparation resulted in decreased IBP, fewer repeated procedures, shorter LOS, and lower hospital cost. 18 Our study adds to these tools by identifying three additional risk factors which could be optimized for inpatients. Because our findings are observational, they should be subjected to prospective trials.…”