Patients missing colonoscopy appointments or arriving with inadequate bowel preparations result in delays in care and lost revenue. The aim of this study was to evaluate the effect of an automated time-released colonoscopy reminder program on preparation quality and the rates of canceled procedures.
Colonoscopy preparation instructions and appointment reminders were delivered to patients via an automated time-released HIPAA-compliant software platform (Medumo Inc., Boston, MA) via text messages and emails. The reminders included 20 text messages and/or emails that were specific to the patient’s preparation type, sedation type and procedure location. The first reminder was delivered the day after colonoscopy booking and the last message was delivered the day after the colonoscopy was completed, at which time patients were asked to complete a survey on their experience. All patients who were scheduled for a colonoscopy at our institution from March through June 2017 were enrolled in the reminder program. Exclusion criteria were absence of preparation type in the procedure request, procedures performed by surgeons, and absence of email address and cell phone number in the medical record. Primary outcome metrics included rate of inadequate bowel preparation, rate of canceled procedures and patient satisfaction with care. Outcomes of the intervention group were compared to colonoscopies performed from March through June 2016 (baseline cohort). As a secondary analysis, we compared the intervention group to patients who had a colonoscopy from March through June 2017 who were excluded from the reminder program (non-intervention cohort).
There were 1497 patients (40.7% male, mean age 56.4 years) enrolled in the automated reminder program; 1.2% (n=18) opted out of the reminder program. Compared to the baseline cohort, the rate of inadequate bowel preparation decreased 11.5% to 3.8% (p<0.0001). The rate of canceled procedures decreased from 6.1% to 4.3% (p=0.01) with significantly fewer cancelations by female patients during the intervention (female: baseline 6.4% vs intervention 3.8%, p=0.007; male: baseline 5.7% vs intervention 5.1%, p=0.60). These changes resulted in a 1.9% increase in overall completed colonoscopy case volume. In the non-intervention group, the rates of inadequate preparation quality (11.8% vs 11.5%, p=0.89) and procedure cancelation (6.6% vs 6.1%, p=0.71) were similar to the baseline cohort. Average patient satisfaction score was 9.6/10 for the procedural episode of care and 9.1/10 for the reminder program.
Implementation of a program of automated time-released colonoscopy preparation reminders to patients via text messages and emails improved patient preparedness for colonoscopy, with significantly improved bowel preparation quality as well as fewer canceled procedures.
© 2018 Published by Elsevier Inc.