Evidence map›Paper›PMID 33639850›Full record

ArticleBMC gastroenterology2021

A patient-centered framework for health systems engineering in gastroenterology: improving inpatient colonoscopy bowel preparation.

Alexandra T Strauss, Jennifer Yeh, Diego A Martinez, Gayane Yenokyan, Janet Yoder, Ravi Nehra, Tara Feller, Kathy Bull-Henry, Ellen Stein, Lawrence C H Hsu and 3 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC gastroenterology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.3field-weighted citation impact, top 43% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
  2. Factors influencing inpatient bowel preparation: a scoping review.Journal of gastroenterology and hepatology · 2024
    Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 2 institutions in 1 country.

Alexandra T StraussDivision of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N Wolfe St. Blalock 465, Baltimore, MD, 21205, USA. Astraus6@jhmi.edu.ORCID http://orcid.org/0000-0001-6313-7221
Jennifer YehDepartment of Internal Medicine, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21287, USA.
Diego A MartinezDepartment of Emergency Medicine, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21287, USA.
Gayane YenokyanJohns Hopkins Biostatistics Center, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
Janet YoderDepartment of Medical Nursing, Johns Hopkins University, 601 N Caroline St, Baltimore, MD, 21287, USA.
Ravi NehraDepartment of Pharmacy, Johns Hopkins Hospital, 601 N Caroline St, Baltimore, MD, 21287, USA.
Tara FellerDepartment of Pharmacy, Johns Hopkins Hospital, 601 N Caroline St, Baltimore, MD, 21287, USA.
Kathy Bull-HenryDivision of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N Wolfe St. Blalock 465, Baltimore, MD, 21205, USA.
Ellen SteinDivision of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N Wolfe St. Blalock 465, Baltimore, MD, 21205, USA.
Lawrence C H HsuOperations Integration, Johns Hopkins Health System, 601 N Caroline St, Baltimore, MD, 21287, USA.
Haitham Al-GrainDepartment of Anesthesiology, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21287, USA.
Candice ZabkoDepartment of Medical Nursing, Johns Hopkins University, 601 N Caroline St, Baltimore, MD, 21287, USA.
Christopher FainDivision of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N Wolfe St. Blalock 465, Baltimore, MD, 21205, USA.
Johns Hopkins University · USJohns Hopkins Hospital · US

Funding

BASIC SCIENCE RESEARCH IN DIGESTIVE DISEASEST32DK007632 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI DONOWITZ, MARK · 1989 to 2018
$5.4M
Foundation for the National Institutes of Health T32DK007632NIDDK NIH HHS T32 DK007632
6 · The paper itself

Abstract

backgroundInpatient colonoscopy bowel preparation (ICBP) is frequently inadequate and can lead to adverse events, delayed or repeated procedures, and negative patient outcomes. Guidelines to overcome the complex factors in this setting are not well established. Our aims were to use health systems engineering principles to comprehensively evaluate the ICBP process, create an ICBP protocol, increase adequate ICBP, and decrease length of stay. Our goal was to provide adaptable tools for other institutions and procedural specialties.

methodsPatients admitted to our tertiary care academic hospital that underwent inpatient colonoscopy between July 3, 2017 to June 8, 2018 were included. Our multi-disciplinary team created a protocol employing health systems engineering techniques (i.e., process mapping, cause-effect diagrams, and plan-do-study-act cycles). We collected demographic and colonoscopy data. Our outcome measures were adequate preparation and length of stay. We compared pre-intervention (120 ICBP) vs. post-intervention (129 ICBP) outcomes using generalized linear regression models. Our new ICBP protocol included: split-dose 6-L polyethylene glycol-electrolyte solution, a gastroenterology electronic note template, and an education plan for patients, nurses, and physicians.

resultsThe percent of adequate ICBPs significantly increased with the intervention from 61% pre-intervention to 74% post-intervention (adjusted odds ratio of 1.87, p value = 0.023). The median length of stay decreased by approximately 25%, from 4 days pre-intervention to 3 days post-intervention (p value  = 0.11).

conclusionsBy addressing issues at patient, provider, and system levels with health systems engineering principles, we addressed patient safety and quality of care provided by improving rates of adequate ICBP.

Indexed as

GastroenterologyInpatientsCatharticsColonoscopyHumansPatient-Centered CarePolyethylene GlycolsCatharticsPolyethylene GlycolsBowel preparationColonoscopyHealth systems engineeringQuality improvement

Identifiers

PMID33639850
PMCPMC7912514
OpenAlexW3134467014

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.