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Optimizing Endoscopy Procedure Documentation Improves Guideline-Adherent Care in Upper Gastrointestinal Bleeding.
Yen, Timothy; Jones, Blake; Espinoza, Jeannine M; Singh, Sarguni; Pell, Jonathan; Duloy, Anna; Wani, Sachin; Scott, Frank I; Patel, Swati G.
Affiliation
  • Yen T; Division of Gastroenterology & Hepatology, University of Colorado Anschutz School of Medicine, 12631 E 17Th Avenue, B158, Aurora, CO, 80045, USA. TimothyYen@llu.edu.
  • Jones B; Division of Gastroenterology & Hepatology, University of Colorado Anschutz School of Medicine, 12631 E 17Th Avenue, B158, Aurora, CO, 80045, USA.
  • Espinoza JM; Division of Gastroenterology & Hepatology, University of Colorado Anschutz School of Medicine, 12631 E 17Th Avenue, B158, Aurora, CO, 80045, USA.
  • Singh S; Division of Hospital Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
  • Pell J; Division of Hospital Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
  • Duloy A; Division of Gastroenterology & Hepatology, University of Colorado Anschutz School of Medicine, 12631 E 17Th Avenue, B158, Aurora, CO, 80045, USA.
  • Wani S; Division of Gastroenterology & Hepatology, University of Colorado Anschutz School of Medicine, 12631 E 17Th Avenue, B158, Aurora, CO, 80045, USA.
  • Scott FI; Division of Gastroenterology & Hepatology, University of Colorado Anschutz School of Medicine, 12631 E 17Th Avenue, B158, Aurora, CO, 80045, USA.
  • Patel SG; Division of Gastroenterology & Hepatology, University of Colorado Anschutz School of Medicine, 12631 E 17Th Avenue, B158, Aurora, CO, 80045, USA.
Dig Dis Sci ; 68(6): 2264-2275, 2023 06.
Article in En | MEDLINE | ID: mdl-36645637
BACKGROUND AND AIMS: Upper GI bleeding (UGIB) is a common indication for inpatient esophagogastroduodenoscopy (EGD). Guideline adherence improves post-EGD care, including appropriate medication dosing/duration and follow-up procedures that reduce UGIB-related morbidity. We aimed to optimize and standardize post-EGD documentation to improve process and clinical outcomes in UGIB-related care. METHODS: We performed a prospective quality improvement study of inpatient UGIB endoscopies at an academic tertiary referral center during 6/2019-7/2021. Guidelines were used to develop etiology/severity-specific electronic health record note templates. Participants (39 faculty/15 trainees) completed 10-min training in template content/use. We collected pre/post-intervention process data on "Minimal Standard Report" (MSR) documentation including patient disposition, diet, and medications. We also recorded documentation of re-bleed precautions and follow-up procedures. Study outcomes included guideline-based medication prescriptions, ordering of follow-up EGD, and post-discharge re-bleeding. Pre/post-intervention analysis was performed using chi-square tests. RESULTS: From a pre-intervention baseline of 199 patients to 459 patients post-intervention, compliance improved with inpatient PPI (53.4-77.9%, p < 0.001) and discharge PPI (31.3-61.0%, p < 0.001) prescriptions. There was improvement in MSR completion (28.6-42.5%, p < 0.001). Compliance improved with octreotide prescriptions (75.0-93.6%, p = 0.002) and follow-up EGD order (61.3-87.1%, p < 0.001). There was no change in post-discharge re-bleeding. 82.6% of cases used templates. CONCLUSIONS: Our project leveraged endoscopy software to standardize documentation, resulting in improved clinical care behavior and efficiency. Our intervention required low burden of maintenance, and sustainability with high utilization over 9 months. Similar endoscopy templates can be applied to other health systems and procedures to improve care.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patient Discharge / Aftercare Type of study: Diagnostic_studies / Guideline / Observational_studies Limits: Humans Language: En Journal: Dig Dis Sci Year: 2023 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patient Discharge / Aftercare Type of study: Diagnostic_studies / Guideline / Observational_studies Limits: Humans Language: En Journal: Dig Dis Sci Year: 2023 Document type: Article Affiliation country: Country of publication: