GI disease-associated care accounts for roughly 3 million hospitalizations annually in the U.S.

Since endoscopy is often an integral part of GI disease management, inpatient endoscopic procedural delays can greatly impact quality of care and length of hospital stays, driving up costs and increasing the likelihood of adverse patient events.

A new report seeks to identify primary reasons for inpatient endoscopy delay and to evaluate the impact of those postponements on hospital systems.

The American Gastroenterological Association published “Factors Associated With Inpatient Endoscopy Delay and its Impact on Hospital Length-of-Stay and 30-Day Readmission” in June 2021. Dr. Chelsea Jacobs, of the department of internal medicine at the University of Florida, headed the study, which included a review of endoscopy procedures between November 2017 and November 2019 at a 1,049-bed tertiary care center.

Approximately 20 percent of patients had endoscopies delayed during the study period, and that resulted in an average of two days longer in the hospital for those patients, according to the study. That’s significant because a longer hospital stay increases the risk of nosocomial infections and can impact quality of care and patient satisfaction.

Key Drivers of Delay

Researchers measured inpatient endoscopic delay by comparing the scheduled procedure day with the day the endoscopy was performed. Jacobs and co-authors found that poor bowel prep was the primary reason for inpatient endoscopic delay at University of Florida Health Shands Hospital.

Close behind was a lack of personnel or endoscopy unit availability, mostly due to increased procedure demand. The medical center has four endoscopy unit procedure rooms, with scheduled blocks for inpatient procedures, and a full on-call team available for weekend cases.

Older patients and women were more likely to experience delays in care, according to the report. In addition, patients admitted to the hospital for non-GI-specific reasons were more likely to have procedures delayed than those directly admitted for GI problems.

Shifting to Outpatient

“Identification of modifiable barriers to timely inpatient procedure is crucial to reduce unnecessary delays in patient care,” the study noted.

Aside from improvements in patient bowel prep, Jacobs and her colleagues also explored ways to reduce delays as they related to staff and procedural room availability. One possible approach would be to address the decision structure in an academic institution, as interns, fellows, and attending physicians all weigh in.

Large tertiary care centers could also streamline patient flow and reduce non-endoscopy time between cases, the authors noted. Ultimately, moving inpatient procedures elsewhere is likely the best way to address delays, the study found. Outpatient services may be more appropriate for stable patients with non-emergent indications.

Reducing procedural delays would also decrease hospital readmission rates, the authors concluded, as those patients who experienced delay were more likely to return to the hospital within 30 days for care.