When a patient arrives for their colonoscopy inadequately prepped, the procedure takes longer to perform, or must be canceled, which interrupts clinical workflow at significant cost.
“To improve patient preparations and decrease no-show rates, a multidisciplinary team at the Endoscopy Center at Brigham and Women’s Hospital (BWH) conducted a three-month pilot study using a texting tool to provide patients with a digital colonoscopy prep guide before their procedure,” said Jennifer Nayor, MD, an attending physician in the Division of Gastroenterology, Hepatology and Endoscopy at BWH.
Mobile-based colonoscopy prep guide sends automated reminders to patients
At predetermined intervals, patients received text messages with instructions and reminders explaining what steps they needed to complete at that time. These included notifications about when to stop eating solid food, or when to consume the laxative prep solution. The most texts were delivered the day before the colonoscopy when patients consumed the prep.
The digital communication tool was developed by the company Medumo, which was co-founded by Omar Badri, MD, a fifth-year resident in internal medicine and dermatology at BWH. When used for patients undergoing colonoscopy, the tool has been shown in trials to reduce no-shows, improve patient preparedness and satisfaction, and increase cancer detection rates.
Results showed reduced no-show rates and lower inadequate prep quality
Prior to the three-month pilot study, 11.5 percent of Endoscopy Center patients were found to have inadequate prep quality within a three-month period. After the intervention, that fell to 3.8 percent. In addition, the no-show rate dropped from 6.1 percent to 4.3 percent. Dr. Nayor presented a poster at the Digestive Disease Week Conference in June of 2018.
“I anticipated that we would see an improvement, but the preliminary results were beyond what I expected, and it continues to be successful. Our staff has been thrilled with the quality of the preps they are seeing and the feedback has also been positive from patients,” said Dr. Nayor who was lead author on the study and collaborated with Aiden Feng, MD, MBA, a first-year anesthesia resident at BWH. Overseeing the research project was John Robinson Saltzman, MD, Director of Endoscopy at BWH.
The mobile-based program also tracks patient progress and can notify a clinician if patients fail to engage, or have an issue during the preparation period, and allows for tracking of patient satisfaction and engagement.
Reducing costs by improving clinical outcomes
As part of their application for funding to the Brigham Care Redesign Incubator Startup Program (BCRISP), the Endoscopy Center conducted an in-depth analysis of the costs associated with each activity in the care pathway.
Their analysis showed that one inadequately prepared patient costs BWH over $1,000. In fact, eight percent of procedures cancelled each year are due to inadequate preparation. These costs include the cost of idle labor, the cost of re-education and rescheduling, and the opportunity cost of forgone revenue.
“Improving patient preparedness results in substantial cost savings. For example, lowering the cancelation and no-show rate from eight percent to four percent results in significant savings,” said Dr. Nayor.
Digital innovations pave the way for a healthier future
Given the positive return on investment, the program can be funded with cost savings, and the mobile-based colonoscopy preparation guide is offered to patients on an ongoing basis. The Endoscopy Center received additional funding to improve the software to remind patients to schedule their colonoscopy after their order has been scheduled.
“Innovative projects such as this help ensure we’re doing everything we can to optimally prepare patients for their procedures,” said Beth McDonald, MBA, RN, executive director of Surgical and Procedural Services. “It’s not only about using our resources efficiently. It’s just as important that we provide the best possible experience for our patients and staff.”
To refer a patient to a Brigham and Women’s Hospital gastroenterologist, call 1-800-MD-TO-BWH (800-638-6294) or fill out this online request form.