Provider acceptance, safety, and effectiveness of a computer-based decision tool for colonoscopy preparation

PURPOSE To assess provider acceptance of recommendations by a decision tool that scans the electronic medical record and determines whether sodium phosphate may be taken. In addition, to determine decision tool effects on a composite outcome of colonoscopies canceled, rescheduled, aborted, or repeated sooner than recommended due to preparation (prep) quality; prep quality; colonoscopy duration; and patient satisfaction with and tolerance of the preparation. METHODS We used 4 alternating 4-week periods to compare the decision tool with usual care for outpatient colonoscopy. All decision tool decisions were reviewed in real-time by gastroenterology nurses and/or physicians. Patients completed a survey about the prep process. Endoscopists blindly rated prep quality. Colonoscopy duration and findings were recorded. RESULTS Of 354 persons in the decision tool group, 4 prep decisions were overridden because of patient preference or prior prep failure, but none for medical reasons. Sodium phosphate was used more frequently in the decision tool group (73% vs. 41%; P < 0.01). There was no difference between the decision tool and usual care groups in the composite outcome (26% vs. 30%, respectively; P = 0.29), acceptable prep quality (62% vs. 56%; P = 0.22), colonoscopy duration (28 vs. 30 min; P = 0.17), patient satisfaction (P = 0.38), or preparation tolerance (P = 0.37). CONCLUSIONS An electronic medical record-based decision tool can safely and effectively tailor the prep for colonoscopy and may improve colonoscopy efficiency and patient satisfaction. LIMITATIONS This study was performed at a single VA medical center and endoscopy unit, relies on the presence of relevant medical conditions and laboratory data in the electronic medical record, and had a higher than expected use of sodium phosphate during usual care.

[1]  V. Sharma,et al.  Prospective, randomized, controlled comparison of the use of polyethylene glycol electrolyte lavage solution in four-liter versus two-liter volumes and pretreatment with either magnesium citrate or bisacodyl for colonoscopy preparation. , 1998, Gastrointestinal endoscopy.

[2]  E. J. Mayeaux,et al.  Rapid estimate of adult literacy in medicine: a shortened screening instrument. , 1993, Family medicine.

[3]  T. Imperiale,et al.  Meta‐analysis: randomized controlled trials of 4‐L polyethylene glycol and sodium phosphate solution as bowel preparation for colonoscopy , 2010, Alimentary pharmacology & therapeutics.

[4]  S. Achem,et al.  A comparison of the effectiveness and patient tolerance of oral sodium phosphate, castor oil, and standard electrolyte lavage for colonoscopy or sigmoidoscopy preparation. , 1993, The American journal of gastroenterology.

[5]  D. Riff,et al.  Efficacy and safety of sodium phosphate tablets compared with PEG solution in colon cleansing: two identically designed, randomized, controlled, parallel group, multicenter phase III trials. , 2001, Gastrointestinal endoscopy.

[6]  William O Thompson,et al.  Low Volume Bowel Preparation for Colonoscopy: Randomized, Endoscopist-Blinded Trial of Liquid Sodium Phosphate Versus Tablet Sodium Phosphate , 2003, American Journal of Gastroenterology.

[7]  G. Plosker,et al.  Oral sodium phosphate solution: a review of its use as a colorectal cleanser. , 2004, Drugs.

[8]  Heitham Abdul-Baki,et al.  A randomized single-blind trial of split-dose PEG-electrolyte solution without dietary restriction compared with whole dose PEG-electrolyte solution with dietary restriction for colonoscopy preparation. , 2005, Gastrointestinal endoscopy.

[9]  Jai Radhakrishnan,et al.  Acute phosphate nephropathy following oral sodium phosphate bowel purgative: an underrecognized cause of chronic renal failure. , 2005, Journal of the American Society of Nephrology : JASN.

[10]  Jonathan A. Leighton,et al.  Patient Preference and Acceptance with Sodium Phosphate Tablet Preparation for Colonoscopy , 2008, Digestive Diseases and Sciences.

[11]  K. Khanduja,et al.  Colonoscopic bowel preparations—Which one? , 1995, Diseases of the colon and rectum.

[12]  Hulya Akgun,et al.  Renal failure and nephrocalcinosis associated with oral sodium phosphate bowel cleansing: clinical patterns and renal biopsy findings. , 2006, Archives of pathology & laboratory medicine.

[13]  W G Paterson,et al.  A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy. , 1990, The American journal of gastroenterology.

[14]  M. Perazella,et al.  Acute phosphate nephropathy. , 2009, Kidney international.

[15]  D. Frommer,et al.  Cleansing ability and tolerance of three bowel preparations for colonoscopy , 1997, Diseases of the colon and rectum.

[16]  J. Barthel,et al.  Prospective, randomized trial comparing a new sodium phosphate-bisacodyl regimen with conventional PEG-ES lavage for outpatient colonoscopy preparation. , 1995, Gastrointestinal endoscopy.

[17]  J. Nogueras,et al.  Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods , 1994, Diseases of the colon and rectum.

[18]  W. Paterson,et al.  Safety profile of 5-h oral sodium phosphate regimen for colonoscopy cleansing: lack of clinically significant hypocalcemia or hypovolemia. , 1995, The American journal of gastroenterology.

[19]  Fadi H Mourad,et al.  A randomized single-blind trial of whole versus split-dose polyethylene glycol-electrolyte solution for colonoscopy preparation. , 2003, Gastrointestinal endoscopy.

[20]  R. Beart,et al.  Oral fleet® phospho®-soda laxative-induced hyperphosphatemia and hypocalcemic tetany in an adult , 1997, Diseases of the colon and rectum.

[21]  D. Rex,et al.  Safety and efficacy of two reduced dosing regimens of sodium phosphate tablets for preparation prior to colonoscopy , 2002, Alimentary pharmacology & therapeutics.

[22]  T. Imperiale,et al.  Meta-analysis and cost comparison of polyethylene glycol lavage versus sodium phosphate for colonoscopy preparation. , 1998, Gastrointestinal endoscopy.

[23]  Giovanni Riccio,et al.  Effective bowel cleansing before colonoscopy: a randomized study of split-dosage versus non-split dosage regimens of high-volume versus low-volume polyethylene glycol solutions. , 2010, Gastrointestinal endoscopy.

[24]  Howard Schwartz,et al.  Safety and Colon-Cleansing Efficacy of a New Residue-Free Formulation of Sodium Phosphate Tablets , 2006, The American Journal of Gastroenterology.

[25]  C. Sohn,et al.  Quality and effect of single dose versus split dose of polyethylene glycol bowel preparation for early-morning colonoscopy , 2007, Endoscopy.

[26]  W A Bauman,et al.  The renal safety of bowel preparations for colonoscopy: a comparative study of oral sodium phosphate solution and polyethylene glycol , 2007, Alimentary pharmacology & therapeutics.

[27]  Mark Avigan,et al.  Sodium Phosphate Tablets and Acute Phosphate Nephropathy , 2009, The American Journal of Gastroenterology.

[28]  Todd H Baron,et al.  A consensus document on bowel preparation before colonoscopy : Prepared by a Task Force , 2022 .

[29]  G. Plosker,et al.  Oral Sodium Phosphate Solution , 2012, Drugs.

[30]  W. Lipshutz,et al.  A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda. , 2000, Gastrointestinal endoscopy.