Jennifer Nayor speaks with patient Inez Codling prior to her upper endoscopy and colonoscopy at the Endoscopy Center.

Preparing for a colonoscopy can be a complex and sometimes confusing experience for patients, requiring a series of time-sensitive actions and dietary changes in the days leading up to the procedure. The process leaves ample room for human error, as it’s easy to forget a step or misunderstand an instruction.

But when a patient arrives for a colonoscopy inadequately prepped, the procedure takes longer to perform or must be canceled because the provider cannot obtain a clear view of the bowels. What’s more, a poor prep usually isn’t evident until after the care team has sedated the patient and inserted the scope.

“Colonoscopy preps are not the easiest thing to do, even with instructions,” said Jennifer Nayor, MD, of the Division of Gastroenterology, Hepatology and Endoscopy. “It’s unfortunate because if the prep is inadequate, we often have to abort the colonoscopy or not even start, which means the patient has to reschedule and do the prep all over again.”

Following a successful pilot last year, staff at the Endoscopy Center are using technology to make that less likely to occur. With funding from the Brigham Care Redesign Incubator Startup Program (BCRISP) and additional support from the Brigham Digital Innovation Hub (iHub), a multidisciplinary team has been using a texting tool, developed by a company called Medumo, to provide patients with a digital colonoscopy prep guide in advance of their procedure.

At predetermined intervals, patients receive automated instructions and reminders via text message explaining what steps they need to complete at that time. These include timely notifications about when to stop eating solid food or when to consume the laxative prep solution, among other check-ins. On the day of their procedure, patients also receive a text with directions to the center using BWH’s new wayfinding tool.

Prior to the intervention, 11.5 percent of Endoscopy Center patients were found to have inadequate prep quality within a three-month period. After the three-month pilot, that fell to 3.8 percent. In addition, the no-show rate dropped from 6.1 percent to 4.3 percent.

“I anticipated that we’d see an improvement, but the preliminary results were beyond what I expected, and it continues to be successful,” Nayor said. “The feedback has also been really positive from patients. They like the idea that we’re helping them through this.”

Patients who participated in the pilot rated their satisfaction with the digital reminders highly, 9.07 on a scale of one to 10. “I felt like someone cared,” noted one patient in a feedback form. Another wrote, “I really love the reminders. I don’t think I could go through the process without the instructions program.” One participant praised the clear, step-by-step instructions and real-time reminders via text message as a “great system that makes the patient feel cared for.”

Looking Ahead

The Endoscopy team has partnered with iHub to make the technology even easier for the clinical staff to use. Originally, staff had to manually input data from Epic into Medumo for each patient. Through the team’s collaboration with iHub, that transfer is now automated at the time of scheduling.

The Endoscopy Center is also looking at expanding its use of Medumo to additional types of automated reminders for patients, Nayor said.

Based on the team’s outcomes, other practices across Brigham Health are evaluating the tool’s use as part of Active Asset Management – an initiative focused on improving the effective utilization of resources – said Beth McDonald, MBA, RN, executive director of Surgical and Procedural Services.

“Innovative projects such as this help ensure we’re doing everything we can to optimally prepare patients for their procedures,” McDonald said. “It’s not only about using our resources efficiently. It’s just as important that we provide the best possible experience for our patients and staff.”

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