An integrated electronic health record-based workflow to improve management of colonoscopy-generated pathology results

An integrated electronic health record-based workflow to improve management of colonoscopy-generated pathology results

Blog Article

Spencer D Dorn, Holly O Cirri, Audrey O Chang, Seth D Crockett, Joseph A Galanko, John A Baron Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA Purpose: Managing and communicating colonoscopy-generated pathology results and appropriate follow-up recommendations can be challenging.To improve this process, we developed and implemented a standardized electronic health record-based intervention with built-in decision support.Methods: Fourteen attending endoscopists performed enough colonoscopies to qualify for the study.For each, we randomly sampled and abstracted data from 35 colonoscopies that met prespecified inclusion criteria during both the pre-intervention and also post-intervention periods.Follow-up recommendations were compared to guidelines.

We used the Wilcoxon Signed Rank Test to assess the change in the proportion of cases with guideline-concordant results, the proportion with a documented follow-up result letter, and the median time to letter completion.A brief survey Peanuts assessed endoscopists’ Oven Handle End satisfaction with the intervention.Results: In total, 1,947 colonoscopies were extracted, of which 968 met inclusion criteria.The proportion of follow-up recommendations that were guideline concordant increased from a median of 82.9% pre-intervention to 85.

7% post-intervention (P=0.72).The proportion of observations with a documented follow-up result letter increased from a median of 88.9% pre-intervention to 97.1% post-intervention (P=0.

07).The number of calendar days between the date of the colonoscopy and the date the letter was sent decreased from a median of 7.7 days pre-intervention to 6.8 days post-intervention (P=0.79).

Eighty-six percentage of endoscopists were either “very satisfied” or “satisfied” with the overall process.Conclusion: The intervention was not associated with a statistically significant increase in guideline-concordant recommendations or efficiency measures, perhaps due to high baseline performance.The intervention was well received by endoscopists and captured data necessary for important downstream processes.Keywords: colonoscopy, pathology, quality, electronic health record, systems.