TITLE

INPATIENT COLONOSCOPY AND FLEXIBLE SIGMOIDOSCOPY—AN INFERIOR SERVICE?

AUTHOR(S)
Metcalf, C.; Graham, R.; Macfarlane, B.; Meyrick-Thomas, J.; Dracup, S.; McNeice, J.; Leahy, A.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA77
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Introduction: A recent retrospective audit of 3455 colonoscopies within our unit found that non-elective inpatient procedures were less likely to be completed to the caecum (77%) than in outpatients (89%). Despite this finding, abnormal examinations were more common in inpatients. Endoscopists and nursing staff have long suspected that inpatients might be less adequately prepared and informed than outpatients. We therefore conducted a prospective audit to investigate such disparities. Aim: To compare the quality of inpatient to outpatient lower gastrointestinal endoscopy. Method: A prospective audit was performed using standardised questionnaires completed by patients, endoscopy nursing, and medical staff. Bowel preparations used were Fleet Phospha-soda (colonoscopy: COL) and phosphate enema (flexible sigmoidoscopy: FS). All outpatients received procedural information leaflets, while all inpatients had access to ward based information sheets. Statistical analyses employed were the students t-test and chi-square test. Results: Procedures audited were 183 COL and 111 FS (34 inpatient, 260 outpatient}. Inpatients were less likely to understand the indication and reason for the procedure or to recall receiving an information sheet (p < 0.05). For both COL and FS the bowel was less well prepared in inpatients (COL p < 0.03, FS p < 0.001). Inpatients had a higher mean American Society for Anesthesiology score (p < 0.001 ). There was no difference between the two groups with regards to side effects of the bowel preparation, sedation used, and duration or discomfort of the procedure as assessed by patient, endoscopy nurse, or endoscopist. Conclusions: Inpatients are frailer and less well prepared for lower Gl endoscopy in terms of both the quality of the bowel preparation and information they receive. This has implications regarding the consenting process and procedural completion rates. Endoscopy units should consider new ways of working in order to improve inpatient...
ACCESSION #
9747803

 

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