Shah-Khan Sardar Musa, Cumberledge Jeremy, Reynolds Gorman Joel
Department of Medicine, West Virginia University, Morgantown, West Virginia, USA.
Department of Digestive Diseases, West Virginia University, Morgantown, West Virginia, USA.
BMJ Open Qual. 2017 Dec 3;6(2):e000230. doi: 10.1136/bmjoq-2017-000230. eCollection 2017.
Poor inpatient colonoscopy preparations can provide multiple challenges to healthcare providers and patients alike. Poor preparations can make the colonoscopy difficult to perform, and can require the procedure to be repeated. This can in turn lead to greater costs, longer length of stays, less patient satisfaction and worse outcomes. The aim of this quality improvement project was to decrease the rate of poor inpatient colonoscopy preparations using the plan-do-study-act approach. Inpatient colonoscopies at our institution from a 3-month span (November 2016 to January 2017) were evaluated, and found to have a 19% rate of poor preparations. A multiphase intervention programme was then conducted to improve the quality of these preparations. This intervention programme was threefold, and involved (1) direct education to physicians and nursing staff on the preparation process and its importance; (2) the implementation of an electronic order set within our electronic medical record (EMR) to standardise and simplify the process of ordering colonoscopy preparations; and (3) patient education in the form of a handout explaining the steps and importance of a good preparation. Through these interventions, we were able to bring down our rate of poor preparations over a 3-month average from 19% to 4%. Specifically, the implementation of an electronic order set within our EMR resulted in the greatest impact. Our interventions can be replicated at other institutions in order to decrease the rate of poor preparations, and thus result in better outcomes for patients, providers and healthcare facilities.
住院患者结肠镜检查准备不佳会给医护人员和患者都带来诸多挑战。准备不佳会使结肠镜检查难以实施，可能需要重复进行该检查。这进而会导致成本增加、住院时间延长、患者满意度降低以及预后变差。这个质量改进项目的目的是采用计划 - 实施 - 研究 - 改进方法来降低住院患者结肠镜检查准备不佳的发生率。对我们机构在3个月期间（2016年11月至2017年1月）进行的住院患者结肠镜检查进行了评估，发现准备不佳的发生率为19%。随后开展了一个多阶段干预项目以提高这些准备工作的质量。这个干预项目有三个方面，包括（1）对医生和护理人员进行关于准备过程及其重要性的直接教育；（2）在我们的电子病历（EMR）中实施电子医嘱集，以规范和简化结肠镜检查准备的医嘱流程；（3）以发放手册的形式对患者进行教育，解释良好准备的步骤和重要性。通过这些干预措施，我们得以将3个月平均的准备不佳发生率从19%降至4%。具体而言，在我们的电子病历中实施电子医嘱集产生的影响最大。我们的干预措施可以在其他机构复制，以降低准备不佳的发生率，从而为患者、医护人员和医疗机构带来更好的结果。
