Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bartlett 920, Boston, MA, 02114, USA.
Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.
Dig Dis Sci. 2018 Feb;63(2):338-344. doi: 10.1007/s10620-017-4896-0. Epub 2018 Jan 4.
Hospitalized patients completing bowel preparation for colonoscopy typically have preparations of poorer quality when compared to outpatient populations.
Our study aimed to evaluate the effectiveness of a performance improvement program in improving colonoscopy preparation for an inpatient population.
We identified a cohort of adult patients (n = 641) undergoing an inpatient colonoscopy during a 12-month period at an academic medical center and compared a multifactor intervention group to a historical baseline group. During this 12-month period, a performance improvement program including use of a dedicated gastrointestinal nurse facilitator, implementation of standardized order sets, and introduction of split bowel preparations in the inpatient setting was made available to the cohort group.
The primary outcome was quality of bowel preparation for colonoscopy as rated by endoscopists using the modified Aronchick scale. When comparing the baseline group to the intervention group, the rate of acceptable preparations, characterized as excellent, good, or adequate, increased from 69.9 to 78.9%, which was statistically significant (p < 0.001).
A comprehensive performance improvement program improved the quality of colonoscopy preparation among inpatients. The use of a dedicated gastrointestinal nurse facilitator, implementation of standardized order sets, and introduction of split bowel preparations are recommended in the inpatient setting for an effective bowel preparation.
与门诊人群相比，住院患者进行结肠镜检查的肠道准备通常质量较差。
我们的研究旨在评估一项绩效改进计划在改善住院患者结肠镜检查准备方面的有效性。
我们确定了一个在学术医疗中心进行住院结肠镜检查的成年患者队列（n=641），并将多因素干预组与历史基线组进行了比较。在这 12 个月期间，为队列组提供了一项绩效改进计划，包括使用专门的胃肠科护士促进者、实施标准化医嘱集以及在住院环境中引入分段肠道准备。
主要结局是内镜医生使用改良的 Aronchick 量表评估的结肠镜检查肠道准备质量。与基线组相比，干预组的可接受准备率（表现为优秀、良好或充分）从 69.9%增加到 78.9%，具有统计学意义（p<0.001）。
全面的绩效改进计划提高了住院患者结肠镜检查准备的质量。在住院环境中，建议使用专门的胃肠科护士促进者、实施标准化医嘱集以及引入分段肠道准备，以实现有效的肠道准备。
