of the two groups, as shown in the table. Multivariable regression analysis revealed

Variable Public Assistance Private Insurance p

acteristics of patients, clinical examination and endoscopist data were collected. Bi- and

d nthe indicationbowel prepara sintubation com ois associated w o(p!0.001) and 0 a

r lr u

is higher when m ( vr

t,p ( nir ra

lonoscopy performed, and also as supporting evidence for defense in medico-legal

was suboptimal. A short educational session led to a signicant improvement in thedocumentation. However, further reinforcement may be necessary to achieve a100% compliance with the documentation of quality indicators.

AbstractsSa1419Impact of Education on Improving Documentation of QualityIndicators in Colonoscopy ReportsShreyas Saligram*, Diego Lim, Benjamin R. Alsop, Bhairvi Jani, Ajay Bansal,Amit RastogiGastroenterology, Kansas university of medical center, Kansas city, MOBackground: Several quality indicators of colonoscopy have been established. Theirdocumentation in the colonoscopy report serves as a marker for the quality of co-www.giejournal.orgfactors that are associated with cec l intubation.

ated (related) with cecal intubation ate. In addition there are also endoscopist elated

study shows that patients character stics and examination related variables are associ-

lonoscopies performed by endosco ists during this trial OR 0,992). Conclusio : This(OR 143,4). Also the patints comfoas the diagnoses tumor (OR 21,4)rtscore is a signicandiverticulosis/itis (ORpredictor (OR, 027),4,2) and the numberas wellof co-analysis shows that the bowel prepa ation is the strongest predictor of cecal intu

physicians perform ore colonoscopies p!0.001). The multi ariate

bationlso independently co related with cecal int bation. The cecal intubation

rience (in yeaground were as), the number of co onoscopies performed and the physicians back-

the diagnosis (p!0. 01). Endoscopist rel ted variables such as expe-

ith cecal intubation (p!0.001), as well as the indication for colon scopy

pared with ill bowel preparation (p!0.001). Also the patients c mfort

tion score. Good bowel preparation was a sociated with higher cecal. Examination relatedfor colonoscopy, thefactors that correlatediagnosis, the Gloucewith cecal intubatioster comfort score anwered thedently correlated with cecal intubattion (p!0.001)on were higher age ( !0.001) and ASA-classica-multivariate analyses were performed. Results: In these 1865 colonoscopies a cecalintubation rate of 93,5% was achieved. Patient related characteristics that indepen-

i pN 2,378 1,052 -Percent male 42.9% 40.2% .14Mean age (yr) 56.6 58.3 !.01Fellow involvement 22.2% 23.5% .41Completion Rate* 96.7% 96.2% .48Prep Quality Poor 2.3% 2.1%

Fair 8.0% 8.1% .82Good/Excellent 89.8% 89.8%

ADR Overall 33.8% 32.1% .36Men R 50 yr 42.4% 41.4% .80

Women R 50 yr 32.8% 30.0% .26Screening only 40.3% 36.4% .40Surveillance only 40.8% 46.4% .27Fecal occult blood 39.9% 32.9% .19

Mean number of polyps 1.48 1.48 .93

*Completion rate excludes obstructing mass, severe coliits, or poor prep wherecompletion was not attempted

Sa1418Quality Requirements for Colonoscopy: Which Factors Inuencethe Cecal IntubationBarbara V. Krevelen*, Claudia VerveerGastroenterology, Ikazia Hospital, Rotterdam, NetherlandsIntroduction: In 2014 a nationwide bowel cancer screening starts in the Netherlands.People aged between 55 and 75 years old will be screened every two years with animmunochemical faecal occult blood test (iFOBT). When the test is positive a colo-noscopy will be offered. The Dutch National Institute of Safety en Environment (RIVM)has high quality standards for these colonoscopies, with a cecal intubation rate of atleast 90%. The average cecal intubation in the Ikazia Hospital in 2011 was 89,1%. Thepurpose of this study is to identify factors that have a negative inuence on the cecalintubation. Methods: Between November 1st 2012 en October 15th 2013 we included1865 colonoscopies performed by gastroenterologists, surgeons, an internist and aphysician assistant. Exclusion criteria were emergency colonoscopies, colonoscopieswith general anesthetics, colonoscopies through the stoma, ASA- V classied patients,patients younger then the age of 17 and colonoscopies performed by fellows. Char-that the only predictors of having an adenoma were male sex (ORZ 1.5, p!0.0001)and age (OR Z 1.2 for every 5 year increment in age, p!0.0001). Conclusions: Inthis large safety net hospital, lower SES, as measured by insurance type was notassociated with poorer bowel preparation or lower ADR. These data suggest thatADR benchmarks do not need to be risk-adjusted based on SES or insurance type.Greater access to colonoscopy by lower SES individuals is likely to result in sub-stantial rates of adenoma detection and removal.

Comparison of Patients by Insurance TypeVolwith right hemicolectomy)Adenoma detection rate 286 (58.9%) 281 (58.9%) 0.98Adenoma detection rate (male: female) 280 (60.3%):6 (30%) 273 (59.7%): 8 (40%) 0.49

Sa1420Can the Use of Endoscopy Report Writers Improve the Quality ofColonoscopy?Zeid F. Karadsheh*, Diana Winston, Sanjay Hegde, Harmony AllisonDivision of Gastroenterology, Tufts Medical Center, Boston, MABackground: Colorectal cancer (CRC) is the 2nd leading cause of cancer relateddeath in the U.S. [1]. Colonoscopy is the preferred screening method for CRC.The effectiveness and safety of colonoscopy depends on the quality of the exam,which can vary among endoscopists [2]. The American Society of GastrointestinalEndoscopy (ASGE) and the American College of Gastroenterology (ACG) task forcein 2006 proposed 14 quality indicators for colonoscopy to dene areas for qualityimprovement [2]. Reporting on those measures can promote improvement inquality and outcomes and reduce healthcare cost. Endoscopy report writers ("en-dowriters") are software that create and save reports, images, and videos and may beused as a practice management tool [3]. Endowriters can assist with accurate andtimely collection of endoscopic quality indicators data [4]. Aim: To evaluate availableendowriters and determine their ability to meet the ASGE/ACG proposed qualitymeasures. Method: Data were collected through phone calls and meetings withsoftware representatives. Results: We reviewed 6 endowriters via phone calls (nZ1)and face-to-face meetings (nZ5). Of the 14 quality markers proposed by the taskforce, all endowriters reported on 8 measures (57.1%) which included 1-indicationof the procedure, 2-informed consent, 3-quality of bowel prep, 4-cecal intubationwith photodocumentation, 5-adenoma detection, 6-withdrawal time, 7-perforationrate and 8-postpolypectomy bleeding. The use of recommended postpolypectomyand post cancer resection surveillance was reported on by 3/6 endowriters. Theremaining 5 measures, which include: 1-the use of recommended inammatorybowel disease (IBD) surveillance, 2-obtaining biopsies in patients with chronicdiarrhea, 3-number and distribution of biopsies in patients with IBD, 4-endoscopicCecal intubation rate (excluding patientsume 79, No. 5S : 2014 GAS472/478 (98.7%)TROINTESTINAL462/470 (98.3%)ENDOSCOPY A0.0010.11Photo documentation of the cecumWithdrawal time381(78.5%)1 (0.2%)393 (82.3%)327 (68.5%)0.13!0.001

Cecal landmarks 98 (20.5%) 279 (59.3%) !

Quality of bowel preparation 481(99.1%) 476 (99.7%)NS0.18IndicationConsent for the procedure obtained485 (100%)485 (100%)477 (100%)477 (100%)NSvalueTable 1 Documentation of the

Quality Indicator

Pre-educationGroup N [ 485Post-educationGroup N [ 477p-Quality Indicators of Colonoscopycases. Lack of proper documentation despite conducting a high quality colonoscopy,can be used to insinuate the endoscopist of poor quality exam leading to unfavor-able judgement. Aim: To assess the documentation of the quality indicators of co-lonoscopy in the procedure reports and the impact of an educational session onimproving this documentation. Methods: We reviewed consecutive colonoscopyreports over a 3 month period to evaluate the documentation of the proposedquality indicators of colonoscopy - 1) indication, 2) consent, 3) quality of bowelpreparation, 4) cecal landmarks, 5) photo documentation of cecum, and 6) with-drawal time. We also calculated the cecal intubation rates and the adenoma detec-tion rates (ADR) as actual measures of the quality of colonoscopy. A formalpresentation was then made in a weekly conference enumerating the differentquality indicators and emphasizing the importance of their documentation.Following this, we reviewed the colonoscopy reports prospectively for next 3months for all the above variables. Documentation of the quality indicators beforeand after the educational session was compared by Fishers exact test and a p valueof! 0.05 was considered signicant. Results: 962 consecutive colonoscopies per-formed by 4 GI attendings with or without a trainee, over a 6 month period wereincluded. The mean age of subjects was 63 years and 96% of them were males. 485procedures were performed before and 477 after the educational intervention.Documentation of the indication of the procedure, consent for the procedure andquality of bowel prep was very high and similar in both the pre and post educationgroups (Table 1). The documentation of cecal landmarks and withdrawal time waslow in the pre-educational group - 20.5% and 0.2% respectively. This improvedsignicantly to 59.3% and 68.5% respectively in the post-education group. The cecalintubation rates were very high and similar in the pre and post education groups(98.7% vs 98.3%; p Z 0.11). Similarly, the ADR were similar and exceeded therecommended thresholds in both pre and post education groups (58.9% vs 58.9%; pZ 0.98). Conclusion: Despite performing high quality colonoscopy as evidenced bythe high cecal intubation rates and high adenoma detection rates in the pre-edu-cation group, the documentation of some of the quality indicators of colonoscopyB205

Outline placeholderConclusionsIntroductionMethodsResultsConclusionBackgroundAimMethodsResultsConclusionBackgroundAimMethodResults