2023 General Surgery Presentations

Anna M Stachura, MD; Susan Reynolds, RN; Mary O'Donnell, MD, FACS, FASCRS; Walter Reed National Military Medical Center

Introduction: The American Society of Colon & Rectal Surgeons recommend that asymptomatic persons without any risk factors start colorectal cancer screening at age 45 years.  In the military, active duty, retirees, and dependents have access to primary care and health care coverage for cancer screening. Still, at our military institution, it was found that between 2014 – 2019, there was a 19% cancellation rate of colonoscopies. Although this system acts as socialized healthcare, stewardship is required for management of limited resources: high cancellation rates affect individual care of the patient as well as the system. Beginning in 2021, a nurse-based reminder system was initiated. This quantitative and qualitative study aimed to assess how a nurse-based intervention affects the rate of colonoscopy cancellations in a socialized healthcare system within the Colon & Rectal Surgery Department.  

Methods: A retrospective chart review was performed to identify the total number of colonoscopies performed and/or cancelled by the Colon & Rectal Surgery Department as documented in Endo Pro/GISS scheduling system during August 2021 – June 2022. The reason for cancellation was obtained through chart review.

Results: The rate of colonoscopy cancellations after a nurse-based intervention decreased from 19% to 5%. Patient-initiated reasons (patient reschedule, patient cancel, no driver, no show) for same day cancellation accounted for 44% of overall cancellations between 2021-2022 (Figure 1). Lack of driver or no bowel prep performed did not account for any cancellations. During the nurse-based intervention where patients were called 2 weeks priorto their colonoscopy, it was determined that 30.9% of patients rescheduled their colonoscopy appointment due to personal conflicts, 4.7% of patients reported confusion over prep, 4.7% of patients received the incorrect bowel prep medication/instructions.

This is an on-goning QI project, results for the entire year can be provided by December. 

Conclusion: Socialized healthcare systems have a limited supply of resources. Although patients have the opportunity for equal access to care under this form of healthcare coverage, poor stewardship negatively affects both the patient as well as the system. This quality and improvement study demonstrates that the screening colonoscopy cancellation rate of a population can be improved through healthcare coverage and prudent utilization of resources. Provider-based reminders provide patients with additional information on the importance and process for screening. This addition has minimized unused facility scope time resulting in decreased wait-times for access to care, and for some patients, earlier detection of colorectal cancer.