Improving patient–provider communication after outpatient colonoscopy procedures can reduce the risk for complications and admissions, according to results from two studies presented at ACG 2024. These studies offer gastroenterologists and clinic managers practical insights into methods that can enhance patient communication while optimizing clinic resources.

“Communication in medicine between healthcare providers and patients is critical,” said Seth Gross, MD, a gastroenterologist at NYU Langone Health, in New York City, who was not associated with either study. “Most patients undergoing endoscopic exams will have an uneventful post-procedure course. However, there will be a small group of patients who will have symptoms and need timely advice, especially those patients who might be experiencing a real complication, such as bleeding post polyp removal. Being able to timely communicate allows for high-quality, timely care, which benefits both patient and provider.”

Automated Methods for Post-Procedure Follow-up

The first study, conducted by the Ohio Gastroenterology Group, in Columbus, assessed whether text messages and email better facilitate communication after an endoscopic procedure than phone calls (oral abstract 36).

Investigator Shail Govani, MD, and his team partnered with Orbita, an artificial intelligence company, to develop and deploy an automated outreach system for five ambulatory surgery centers (ASCs).

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More than 80% of people ignore calls from unknown numbers, according Dr. Govani and his co-investigators, and automation offered a structured, multimodal approach to reach patients without relying solely on phone calls. The team sent a one-question survey via email and text message and used a three-step automated sequence for follow-up:

  1. Morning survey link: Patients received a survey link via email at 9 a.m. the day after their procedure, which reduced the chance of missed follow-up, according to the investigators.
  2. Midday text reminder: If the survey link was not accessed by 11 a.m., a reminder was sent via text message, a communication channel preferred by many patients.
  3. Afternoon automated call: A final attempt was made at 3 p.m. through an automated phone call, encouraging patients to connect with the clinic if they had post-procedure concerns.

If a patient affirmed a need for follow-up, they were given a direct line to connect with a nurse, who was alerted to expect the call.

“We wanted to prioritize response rate and minimize intrusiveness to our patients,” Dr. Govani said. “Physician and nursing staff leadership together crafted … a yes or no question and covered our major post-procedure concerns.”

This sequence was tested on nearly 4,000 patients starting in May 2024, and investigators reported that the process was highly effective. More than 60% of patients engaged with the survey through email or text messaging, a significant improvement over the 32.7% engagement rate seen with only manual phone calls.

The nurses and office staff at Ohio Gastroenterology Group, who across the five ASCs perform roughly 40,000 procedures annually, were dedicating about 16 hours per week to phone calls that could be spent on patient care or necessary paperwork, Dr. Govani said.

“Our study showed that previously, only about 1 in 3 patients responded to a phone call,” he said. “Now we are reaching close to 2 in 3 patients with text messages/emails. This is really critical for a large organization like ours, which receives more than a thousand phone calls a day. It allows us to prioritize those patients who do need to speak to us, reducing their wait times.”

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The study found only 4.8% of patients indicated they needed a follow-up. By flagging only symptomatic patients for direct follow-up by staff, this automated approach reduced workload and ensured high-risk patients received personal outreach, Dr. Govani said.

“We were previously using nursing staff to make phone calls,” he explained. “Our nursing staff worked on these calls while performing a variety of tasks, including stocking supplies, [and] preparing and recovering patients after endoscopy. By removing this task, we are able to allow them to focus on their other tasks.”

“A post-procedure phone call is … time-consuming for staff,” Dr. Gross said, and “most patients have an uneventful course. Any strategy that automates part of this process is a win for staff and patients.”

Before the new approach was implemented, the nursing staff also frequently left messages asking patients to call back if they had questions or concerns, Dr. Govani added, but if a patient called the office, they faced long wait times because the nurse was occupied with other phone calls.

Although the automated system integrated easily with their electronic medical record, reducing staff burden while enhancing patient outreach, the team encountered some hurdles to effective communication, he said. “It’s critical to find a technology partner with expertise in this area. There are privacy concerns in addition to technical issues with deploying an automated text message/email system and getting that information back to our staff in a timely manner.”

He also stressed that “we have to ensure correct contact information for patients, including cellphone numbers.” Dr. Govani noted that it is “helpful to share with patients prior to discharge that they should expect a brief survey to improve the response rate.”

Fellow-Initiated Quality Improvement Project

For the second study, Dongmin Shin, MD, an internist at BronxCare Health System, and his team initiated a quality improvement project to improve accessibility to healthcare providers post-procedure, aiming to reduce unplanned hospital visits within seven days of colonoscopy, one of the quality indicators reported to the Centers for Medicare and & Medicaid Services.

This fellow-led project focused on providing direct support to patients by setting up an on-call phone line and scheduling “emergent ambulatory follow-up” slots to promptly address post-procedural concerns (poster 3635).

The investigators assessed an intervention composed of adding an on-call phone number in discharge instructions, allowing patients to directly reach a nurse if they had any concerns after their procedure. The team looked at the charts of 473 patients, 228 before and 245 after the intervention.

Their retrospective analysis showed that providing the phone number in discharge instructions improved patient reachability, increasing communication success from 57.4% pre-intervention to 66.5% post-intervention. The idea behind the intervention, according to the investigators, was that creating same- or next-day appointment slots for post-colonoscopy concerns could help clinicians address issues before they escalated, reducing unnecessary emergency visits.

Although the communication may have improved slightly, the outcomes remained the same. In both study arms, post-procedure pain and discomfort were managed equally. Also, each arm saw only one patient visit the ER in the seven days post-procedure.

Although the post-procedure communication did not significantly affect readmission rates, Dr. Shin acknowledged the study was underpowered to precisely assess the impact of their intervention.

“These two studies show there is certainly more than one way for patients to communicate with their provider,” Dr. Gross said. “One is passive, where the patient must call the number, versus a more active approach by receiving a text message. The text message to the patient ensures all patients have been contacted and it’s automated.” He said he favors a proactive communication strategy because it has the highest likelihood of reaching all patients.

—Jordan Davidson

Dr. Govani reported financial relationships with AbbVie, Bristol Myers Squibb and Orbita. Dr. Gross reported no relevant financial disclosures. He is a member of the Gastroenterology & Endoscopy News editorial board. Dr. Shin reported no relevant financial disclosures.

This article is from the December 2024 print issue.