Improving compliance with postpolypectomy surveillance guidelines: an interventional study using a continuous quality improvement initiative

Background: Despite guidelines, physicians tend to perform postpolypectomy surveillance colonoscopies too frequently. Objective: The objective of the stud), was to determine the baseline compliance rate with postpolypectomy guidelines in our unit and to determine the influence of a Continuous quality improvement (CQI) intervention on improving the compliance rate and on decreasing the potential additional costs because of the scheduling Of postpolypectomy surveillance colonoscopies earlier than indicated. Design: This was a single-arm, pretest-posttest design. Setting: This study took place at a tertiary care, academic medical center. Patients: The medical records of all patients who underwent colonoscopy with polypectomy in our unit retrospectively during 6 months preceding (baseline period) and prospectively for 6 months after an intervention (postintervention period) were reviewed for patient demographics, colonoscopy findings; and scheduling of repeat colonoscopies. Intervention: We used 3 components: (1) distribution of a wallet-size card with a summary of postpolypectolomy guidelines to all endoscopists, (2) placement of guideline charts near computers used for typing endoscopy reports, and (3) distribution and reinforcement of the guidelines in a monthly continuous quality improvement meeting. Main Outcome Measures: The main Outcome measures were compliance rates, mean times to repeat colonoscopy, and additional costs from surveillance colonoscopies being scheduled earlier than indicated were compared between the two periods. Results: There were 278 patients in the baseline period and 242 in the postintervention period, with similar patient and polyp characteristics. After the intervention; the compliance rate with guidelines improved from 57.2% to 81% (p < 0.001). The mean time to a repeat colonoscopy increased from 4.5 t0 5.2 years (p = 0.003) (i.e., a 14% reduction in the number of postpolypectomy surveillance colonoscopies performed per year). This would result in a reduction of a total of 73 surveillance colonoscopies per year in Our unit, with a projected cost savings of $171,331 per year (cost of a colonoscopy assumed at $2347). Limitations: The limitation of the study was possible enhanced performance secondary to being observed (Hawthorne effect). Because more than 1 intervention was used, we do not know which one is more effective. Conclusions: Relatively simple and easy-to-implement quality improvement initiatives can significantly enhance compliance with postpolypectomy guidelines and result in cost savings because of a reduction in the number of postpolypectomy Surveillance colonoscopies being scheduled earlier than recommended guidelines.