Prospective Study of Dot Phrase Instructions to Improve Quality and Timeliness of Bowel Preparation for Inpatient Colonoscopies

Background Inpatient bowel preparation is often suboptimal. Few interventions have been effective at improving its success rate. We determined the clinical features associated with suboptimal inpatient bowel preparation and analyzed the ability of an easily implementable set of instructions inserted into the electronic health record to improve the success of bowel preparation. Methods We prospectively collected bowel preparation outcomes, demographics, and clinical features for inpatient colonoscopies in a tertiary center from July to November 2019, forming the standard of care (SOC) arm. After introducing a standardized set of instructions into the electronic health records using a "dot phrase," data for the intervention arm was collected from December 2019 to May 2020. We compared the outcomes of preparation quality and efficiency between these groups. We calculated avoidable charge estimates to determine the cost savings of our intervention. Groups were combined and multivariate analysis was performed to determine the clinical features independently associated with suboptimal bowel preparation. Results Sixty-eight patients were included in the SOC arm and 76 in the intervention arm. Post-intervention, there was a 36.6% reduction in the number of patients with a suboptimal bowel preparation outcome, though multivariate analysis did not show an independent association with optimal bowel preparation. In the multivariate analysis, only diabetes mellitus (p = 0.046) was independently associated with suboptimal preparation. Conclusions Diabetes mellitus is a non-modifiable risk factor for suboptimal bowel preparation. Our standardized proactive instructions for inpatient bowel preparation administration led to a modest reduction in insufficient bowel preparation. This could lead to significant cost savings.