Duke University Medical Center, Durham, North Carolina, USA.
Duke Clinical Research Institute, Durham, North Carolina, USA.
Int J Health Care Qual Assur. 2020 Mar 9;ahead-of-print(ahead-of-print). doi: 10.1108/IJHCQA-11-2019-0186.
Inpatient colonoscopy bowel preparation quality is frequently suboptimal. This quality improvement (QI) intervention is focused on regimenting this process to impact important outcomes.
DESIGN/METHODOLOGY/APPROACH: Define, Measure, Analyze, Improve and Control (DMAIC) methodology was employed, including generating a root-cause analysis to identify factors associated with inpatient bowel quality. These findings motivated the creation of a standardized electronic health record (EHR)-based order set with consistent instructions and anticipatory guidance for administering providers.
There were 264 inpatient colonoscopies evaluated, including 198 procedures pre-intervention and 66 post-intervention. The intervention significantly improved the adequacy of right colon bowel preparations (75.0 percent vs 86.9 percent, = 0.04) but not overall preparation quality (73.7 percent vs 80.3 percent, = 0.22). The intervention led to numerical improvement in the proportion of procedures in which the preparation quality interfered with making a diagnosis (10 percent-6 percent, = 0.29) or resulted in an aborted procedure (3.5 percent-1.5 percent, = 0.39). After the intervention, provider satisfaction with the ordering process significantly increased (23.3 percent vs 61.1 percent, < 0.001).
The QI intervention significantly reduced the number of inpatient colonoscopies with inadequate preparation in the right colon, while also modestly improving the diagnostic yield and proportion of aborted procedures. Importantly, the standardized EHR order set substantially improved provider satisfaction, which should justify broader use of such tools.
ORIGINALITY/VALUE: Novel clinical outcomes such as ability to answer diagnostic questions were improved using this intervention. The results align with strategic goals to enhance provider experience and continuously improve quality of patient care.
住院患者结肠镜肠道准备质量往往不理想。本质量改进（QI）干预措施侧重于规范这一过程，以影响重要的结果。
方法/方法/方法：采用定义、测量、分析、改进和控制（DMAIC）方法，包括生成根本原因分析，以确定与住院肠道质量相关的因素。这些发现促使创建了一个基于标准化电子健康记录（EHR）的医嘱集，其中包含一致的说明和管理提供者的预期指导。
共评估了 264 例住院结肠镜检查，包括 198 例干预前和 66 例干预后。干预措施显著提高了右结肠肠道准备的充分性（75.0%比 86.9%，=0.04），但整体准备质量没有提高（73.7%比 80.3%，=0.22）。干预措施导致准备质量干扰诊断的程序比例（10%比 6%，=0.29）或导致程序中止的比例（3.5%比 1.5%，=0.39）有所改善。干预后，提供者对医嘱流程的满意度显著提高（23.3%比 61.1%，<0.001）。
QI 干预措施显著减少了右结肠准备不充分的住院结肠镜检查数量，同时适度提高了诊断效果和程序中止的比例。重要的是，标准化的 EHR 医嘱集极大地提高了提供者的满意度，这应该证明更广泛地使用此类工具是合理的。
原创性/价值：使用这种干预措施，提高了回答诊断问题的能力等新的临床结果。结果与增强提供者体验和不断提高患者护理质量的战略目标一致。
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