{
  "abstract": "Introduction Inadequate bowel preparation reduces colonoscopy quality, increases repeat procedures, and strains endoscopy capacity. JAG recommends bowel preparation adequacy in ≥90% of patients, with an aspirational target of 95%. The aim of this quality improvement project was to evaluate a validated, easy-to-use prediction scale that identifies patients at increased risk of inadequate bowel preparation and assess its impact on colonoscopy quality and capacity in non-screening outpatient endoscopy settings. 1Methods We:performed a retrospective audit of 100 consecutive patients who underwent colonoscopy at York & Scarborough Teaching Hospitals (YSTH) to determine the baseline bowel preparation adequacy and apply the prediction scale.implemented and evaluated a prospective nurse led pilot at YSTH offering enhanced bowel preparation to those identified by the prediction scale,introduced the implementation to the four NHS Trusts across the Humber & North Yorkshire Cancer Alliance (HNY CA) with the aim of embedding the innovation into standard care.Outcome measures included bowel preparation adequacy, colonoscopy quality indicators, repeat colonoscopy rates, safety and colonoscopy capacity release.Results Retrospective audit: the median age was 67 years (IQR 55–79). Bowel preparation adequacy (excellent/good/fair) was 72%. 22% of patients required repeat colonoscopy due to inadequate preparation. The scale at ≥2 and ≥3 had sensitivities of 89% and 75% and specificities of 28% and 40% respectively. We estimated that by applying the scale and assuming an effectiveness of enhanced preparation of 70, 80 or 90% that adequacy would increase to between 87 and 94%.Prospective pilot: ninety seven of 237 patients, median age 68 (IQR 54–84), received enhanced bowel preparation and bowel adequacy increased to 92%. (RR 0.30, p<0.001). Excellent/good preparation increased from 39% to 80% (RR 2.06, p<0.001), mean extubation time reduced from 13 to 11.5 minutes, polyp detection improved from 32% to 48% (RR 1.49, p=0.008) and repeat colonoscopies fell to 5%.Regional roll out: interim results at 3 months involving 938 patients, median age 70 (IQR 58–82), confirm the successful implementation with no safety concerns (see table 1).Conclusions Real-world bowel preparation adequacy remains a challenge, impairs quality and drains capacity. An easy-to-use prediction scale can be applied in clinical practice. Supported by the Yorkshire Cancer Research Bowel Cancer Improvement Programme and HNY CA innovation funding we have demonstrated that such a scale can be implemented regionally for patient benefit.Reference Dik, et al. doi.org/10.1016/j.gie.2014.09.066.Abstract FP17 Table 1Impact at 3 months of the prediction scale implementation across the HNY CATrustPatients assessedBaseline bowel prep adequacy %Bowel prep adequacy post implementation %Repeat colonoscopy reduction rate %YSTH298729581HDH100839675HUTH136779159NLAG40483 8854HDH: Harrogate and District; NLAG: North Lincs.",
  "authors": [
    {
      "affiliations": [
        "York and Scarborough Teaching Hospital NHS Foundation Trust, York, United Kingdom"
      ],
      "name": "Dhanushan Gnanendran"
    },
    {
      "affiliations": [
        "Hull York Medical School, Hull, United Kingdom"
      ],
      "name": "Raoul Ovalekar"
    },
    {
      "affiliations": [
        "Hull York Medical School, Hull, United Kingdom"
      ],
      "name": "Amelia Green"
    },
    {
      "affiliations": [
        "Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom"
      ],
      "name": "Priscilla Chong"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom"
      ],
      "name": "Shakeel Majid"
    },
    {
      "affiliations": [
        "York and Scarborough Teaching Hospital NHS Foundation Trust, York, United Kingdom"
      ],
      "name": "Sumanth Shetty"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom"
      ],
      "name": "Thamir Alshamari"
    },
    {
      "affiliations": [
        "York and Scarborough Teaching Hospital NHS Foundation Trust, York, United Kingdom"
      ],
      "name": "James Turvill"
    }
  ],
  "title": "FP17 A risk-stratified, score-targeted bowel preparation pathway improves colonoscopy quality and reduces repeat procedures: a multicentre quality improvement project",
  "uid": "0af0e713-6444-5315-b4dc-784c49bb14b3"
}