Endoscopy 2019; 51(04): S55
DOI: 10.1055/s-0039-1681333
ESGE Days 2019 oral presentations
Friday, April 5, 2019 14:30 – 16:30: Colon cleansing 2 Club D
Georg Thieme Verlag KG Stuttgart · New York

PLAN-DO-STUDY-ACT APPROACH FOR IMPLEMENTING SPLIT REGIMEN OVER SINGLE DOSE (IMPROVES STUDY)

G Vanella
1   Digestive Endoscopy, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
,
C Hassan
2   Nuovo Regina Margherita Hospital, Rome, Italy
,
M De Bellis
3   National Cancer Institute, Naples, Italy
,
M Giardini
4   Urbino Hospital, Urbino, Italy
,
E Grasso
5   Tor Vergata University, Rome, Italy
,
F Laterza
6   Gabriele d'Annunzio University and Foundation, Chieti, Italy
,
O Tarantino
7   San Giuseppe Hospital, Empoli, Italy
,
E Di Giulio
1   Digestive Endoscopy, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Split-dose regimen for colonoscopy is recommended by international guidelines, but its adoption is still suboptimal. The Plan-Do-Study-Act approach (PDSA) is a scientific method used to promote continuous quality improvement of complex processes. The aim of this study was to assess whether PDSA is able to improve adherence to split-dose regimen.

Methods:

According to a PDSA approach, split-dose regimen adoption was assessed in two periods separated by data analysis and tailored interventions, namely: 1) Cycle1: assessment of split dose adherence in consecutive outpatients and inpatients undergoing colonoscopies in 74 Italian centres; 2) Educational intervention: two mandatory meetings with literature review, analysis of Cycle1 data and discussion of hypothetical corrective measures; 3) Cycle2: final assessment of post-interventional adoption of split-dose regimen. Demographic, clinical and procedural variables were systematically collected. Multivariate logistic regression was used to identify predictors of split-dose regimen adoption.

Results:

8,213 patients (mean age 60.29 (SD 13.58), men 54%, outpatients 88.4%) were enrolled between 2013 and 2016 (4,189 in Cycle1 and 4,024 in Cycle2). The Split-dose regimen adoption raised from 29.1% of Cycle1 to 51.1% of Cycle2 (p < 0.0001), and being enrolled in Cycle2 was an independent predictor of Split-dose regimen adoption (OR 2.9; 95% C.I. 2.6 – 3.3). The adoption improved in all time slots, including colonoscopies scheduled before 9:30 am. The main corrective measures were: rescheduling of colonoscopies between 9:30 and 11:30 am (OR 2.6; 95% CI 2.3 – 3.1) and after 11:30 am (OR 7; 95% CI 5.9 – 8.4), the cleansing regimen communicated by the Endoscopy Unit (via form: OR 1.6 95% CI 1.3 – 1.9; via visit: OR 2.1 95% CI 1.7 – 2.5) and by more than one modality (OR 2.8; 95% CI 2.3 – 3.3), a decrease in the use of deep sedation (OR 2; 95% CI 1.7 – 2.5).

Conclusions:

An educational intervention with observation-driven corrections according to a PDSA approach was able to substantially increase the adoption of the split-dose regimen.