S644 Implementing Expedited Colonoscopy Scheduling for High-Risk Patients

Introduction: Due to a multitude of factors, including expanded screening guidelines, colonoscopy wait-times have increased. At our institution, the mean wait-time for average risk screening colonoscopy is approximately 5 months. Higher risk referrals for diagnostic colonoscopy (e.g., positive stool-based testing or rectal bleeding) should generally be performed within 4 weeks, but this can be challenging to operationalize in practice. Our aim for this quality improvement project was to establish an effective mechanism to identify patients needing urgent colonoscopy and implement a process to expedite their appointments. Methods: From March to May 2025, we developed an automated electronic health record query to create a list of patients referred for colonoscopy with the indications of rectal bleeding, positive stool DNA testing, blood in stool, and iron deficiency anemia (“higher-risk patients”). This list included patients whose scheduled colonoscopy appointment was >4 weeks from initial referral and was generated weekly. Clinicians were also engaged to reserve 1-2 additional appointment slots daily for these patients. The office staff was instructed to contact these patients to offer an earlier colonoscopy appointment in one of these held slots. Clinical outcomes of the procedure were also recorded. Results: We identified 221 higher risk patients with an average wait time of 132 days for colonoscopy. Using our process, 85 patients accepted sooner appointments, 51 declined sooner appointments, 17 were deemed low risk/suitable to wait by their physician, 15 have pending appointments, 38 had appointments within 4 weeks of the list generation, and 9 could not be contacted. Since the start of this project, we were able to decrease the mean wait time for colonoscopy to 29 days. Of the 102 patients who have completed colonoscopies thus far, we identified the following: advanced neoplasia (n = 4), inflammatory bowel disease (n = 2), and angiodysplasia (n = 1). Three months after initiating this QI project, the list has decreased by 136 patients. Conclusion: Streamlining an urgent colonoscopy workflow and engagement of physicians to offer expanded hours for higher risk indications significantly reduced wait times for diagnostic colonoscopies. Further work is being pursued to streamline the referral process from primary care as well as identify those with a positive stool DNA who have not been referred.