A Digital Preprocedure Instruction Program for Outpatient Colonoscopy

Effectiveness of Personalised Phone Calls and Short Message Service Reminders in Improving Patient Attendance at a Radiology Department

BACKGROUND

Patients missing scheduled hospital appointments pose significant challenges, including resource waste and delayed patient care. This study evaluated the effectiveness of personalised reminder systems (phone calls and short message service (SMS)) in improving patient attendance rates at a radiology department.

METHODS

The study was conducted at a hospital facility in Saudi Arabia. The intervention involved reminding 493 patients of their radiology appointments using their preferred method (phone call or SMS). Demographic, clinical, and other factors were considered in analysing the impact of these reminders on appointment attendance. Attendance rates before the intervention were further compared with attendance rates after the intervention to assess the effectiveness of the studied strategies.

RESULTS

Patient reminders affected overall patient attendance, with a 5% improvement compared to the attendance rates before the intervention. Phone call reminders were found to be more effective than SMS, particularly among older patients (41-60 years). The attendance rate for patients receiving phone call reminders ranged from 35% to 85%, whereas those receiving SMS reminders had a 15-65% attendance range. The study indicated marital status and distance as key factors associated with attendance. Chi-square analysis also highlighted significant differences in attendance rates before and after the intervention, particularly among female patients, single and divorced individuals, and those with at least secondary education. Patients living more than 35 km from the hospital and those referred from other hospitals were more likely to miss appointments, irrespective of the intervention.

CONCLUSION

Personalised phone call reminders seem to be more effective than SMS in reducing missed appointments, especially among older patients. This study highlighted the importance of considering patient demographics and preferences in designing reminder systems to enhance healthcare appointment adherence.

Evaluating the use of a customized digital navigation program to optimize bowel preparation in pediatric colonsocopy

Introduction

Adequate bowel preparation is essential for optimal colonoscopy diagnosis and/or intervention. However, suboptimal bowel preparation occurs in as many as 1 in 3 pediatric colonoscopies, leading to missed diagnoses, procedural complications, wasted resources, and increased costs. We aimed to evaluate the effect of an automated Pediatric Colonoscopy Digital Navigation Program (PC-DNP) on the quality of colonoscopy preparation among pediatric patients.

Methods

The PC-DNP sent patients timely weight-based bowel preparation instructions, video and text-based educational modules, logistical information, and appointment reminders prior to their scheduled diagnostic and/or therapeutic colonoscopies. Physician reported bowel preparation quality among patients/caregivers who were prescribed the PC-DNP were compared to bowel preparation quality of a historical sample of patients/caregivers who received standard care instructions.

Results

We found that the PC-DNP group had significantly higher bowel preparation quality than the standard care group.

Conclusions

These results demonstrated that automated DNPs may be easily implemented into the pediatric gastroenterologists' practice and may help streamline and improve bowel preparation in pediatric patients.

Preoperative automatic reminder systems and impact on quality and compliance with colonoscopy preparation: A multicenter randomized controlled trial

OBJECTIVES

Traditional preoperative reminding services have been applied to enhance the quality of bowel preparation for colonoscopy. In this study we aimed to evaluate the effectiveness of an automated electronic reminder system (E-reminder) on improving bowel preparation and the quality of preoperative education before colonoscopy.

METHODS

From August 2021 to March 2022, 833 outpatients aged 50-75 years who underwent colonoscopy were included and randomly assigned to the E-reminder group and the control group. While the control group received routine preoperative education. The E-reminder group received automatic phone call, text message reminders and web services regarding the details of bowel preparation before the colonoscopic examination. The quality of bowel preparation was evaluated by the Boston Bowel Preparation Scale (BBPS) score and the previously validated objective evaluation scale of automatic BBPS (e-BBPS).

RESULTS

In manual assessment, the rate of adequate bowel preparation was improved in the E-reminder group of intention-to-treat population using BBPS (60.7% vs 54.5%, P = 0.01). The percentage of objective evaluated adequate bowel preparation using e-BBPS in the E-reminder group of per-protocol population was significantly higher than that in the control group (76.9% vs 69.2%, P = 0.02).

CONCLUSIONS

E-reminder was an effective tool to improve the quality of bowel preparation and compliance with medical instructions. It may be regarded as an efficient and convenient education tool, improving the quality of medical service.

Modelling the no-show of patients to exam appointments of computed tomography

BACKGROUND

Patients' no-shows negatively impact healthcare systems, leading to resources' underutilisation, efficiency loss, and cost increase. Predicting no-shows is key to developing strategies that counteract their effects. In this paper, we propose a model to predict the no-show of ambulatory patients to exam appointments of computed tomography at the Radiology department of a large Brazilian public hospital.

METHODS

We carried out a retrospective study on 8382 appointments to computed tomography (CT) exams between January and December 2017. Penalised logistic regression and multivariate logistic regression were used to model the influence of 15 candidate variables on patients' no-shows. The predictive capabilities of the models were evaluated by analysing the Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC).

RESULTS

The no-show rate in computerised tomography exams appointments was 6.65%. The two models performed similarly in terms of AUC. The penalised logistic regression model was selected using the parsimony criterion, with 8 of the 15 variables analysed appearing as significant. One of the variables included in the model (number of exams scheduled in the previous year) had not been previously reported in the related literature.

CONCLUSIONS

Our findings may be used to guide the development of strategies to reduce the no-show of patients to exam appointments.

Digital Navigation Improves No-Show Rates and Bowel Preparation Quality for Patients Undergoing Colonoscopy: A Randomized Controlled Quality Improvement Study

OBJECTIVES

Because of high historical no-show rates and poor bowel preparation quality in our unit, we sought to evaluate whether text message navigation for patients scheduled for colonoscopy would reduce no-show rates and improve bowel preparation quality compared with usual care.

METHODS

We performed a randomized controlled quality improvement study from April to August 2019 in an urban academic endoscopy unit. All patients scheduled for colonoscopy were randomly assigned to a control group that received usual care (paper instructions/nursing precalls) or to the intervention group that received usual care plus the text message program [short message service (SMS)]. The program provided timed-release instructions on dietary modifications and bowel preparation before colonoscopy. The primary outcome was no-shows. Secondary outcomes were no-show/same-day cancellations, no-show/cancellations within 7 days of the procedure, and bowel preparation quality.

RESULTS

A total of 1625 patients were randomized (SMS=833, control=792). No-show rates were significantly lower in the SMS group compared with the control group (8% vs. 14%; P<0.0001). Similar results were found for no-show/same-day cancellations (10% vs. 16%; P=0.0003), and no-show/cancellations within 7 days (18% vs. 26%; P=0.0008). There was no difference in adequate bowel preparation for all colonoscopies between the groups (89% vs. 87%; P=0.47). However, rates of adequate bowel preparation for screening/surveillance colonoscopies were significantly higher in SMS versus control groups (93% vs. 88%; P=0.04).

CONCLUSIONS

Text message navigation for patients scheduled for colonoscopy improved the quality of colorectal cancer screening by decreasing no-show rates and increasing adequate bowel preparation rates in patients undergoing screening colonoscopy compared with usual care.

Computer-based patient education is non-inferior to nurse counselling prior to colonoscopy: a multicenter randomized controlled trial

BACKGROUND

Optimal patient education prior to colonoscopy improves adherence to instructions for bowel preparation and leads to cleaner colons. We developed computer-based education (CBE) supported by video and 3 D animations. We hypothesized that CBE could replace nurse counselling without loss of bowel preparation quality during colonoscopy.

METHODS

We conducted a prospective, multicenter, endoscopist-blinded, non-inferiority randomized controlled trial. The primary outcome was adequate bowel preparation, evaluated using the Boston Bowel Preparation Scale (BBPS). Secondary outcome measures were: sickness absence for outpatient clinic visits; patient anxiety/satisfaction scores; and information recall. We included patients in four endoscopy units (rural, urban, and tertiary).

RESULTS

We screened 1035 eligible patients and randomized 845. After evaluation, 684 were included in the intention-to-treat (ITT) group. Subsequently, 497 patients were included in the per-protocol analysis, 217 in the nurse counselling and 280 in the CBE group. Baseline characteristics were similarly distributed among the groups. On per-protocol analysis, adequate bowel cleansing was achieved in 93.2 % (261/280) of CBE patients, which was non-inferior to nurse-counselled patients (94.0 %; 204/217), with a difference of -0.8 % (95 % confidence interval [CI] -5.1 % to 3.5 %). Non-inferiority was confirmed in the ITT population. Sickness absence was significantly more frequent in nurse-counselled patients (28.0 % vs. 4.8 %). In CBE patients, 21.5 % needed additional information, with 3.0 % needing an extra outpatient visit.

CONCLUSION

CBE is non-inferior to nurse counselling in terms of bowel preparation during colonoscopy, with lower patient sickness leave. CBE may serve as an efficient educational tool to inform patients before colonoscopy in routine clinical practice.

Tips and pearls on running an endoscopy unit in a cost-efficient manner

Endoscopy units face numerous challenges because of rising demand, increased operational costs, and declining reimbursement. These conditions have led to a critical need to maximize the operational cost-efficiency of these units. Several key factors can affect the cost-efficiency of an endoscopy unit, and the 4 key areas discussed in this article are managing capital costs, efficient use of disposables, improving unit efficiency, and creating a positive culture and establishing strong unit leadership. Areas on which to focus to achieve the greatest results will vary based on specific unit characteristics, but initial efforts should aim to improve operations by focusing on 1 to 2 key areas that ideally have been identified by an internal needs assessment. Although such efforts can be arduous and need to be sustained, they can result in significant benefits to patients, endoscopy unit staff, and healthcare organizations.