Digital pre-procedure reminders to tackle colonoscopy backlog: King’s College Hospital NHS Foundation Trust

Overview

King’s College Hospital NHS Foundation Trust (King’s) implemented a digital pre-procedure reminder system for patients ahead of their colonoscopy procedure to reduce lost appointments and repeat procedures due to poor pre-op preparation. 

What the organisation faced

It is estimated that failed bowel prep causes around 5 per cent of colonoscopies to not go ahead as planned due to patients failing to follow pre-procedure instructions. At King’s this translated to around 1,300 failed appointments each year, which is the equivalent to an annual loss of around £221,340.

In addition to the financial loss, it led to wasted appointments as well as repeat procedures, as inadequate prep reduces procedure quality, prolongs time, may cause adverse outcomes and missed lesions, and overall results in longer waiting times for patients. 

Dr Mayur Kumar, consultant gastroenterologist and clinical lead for endoscopy at the Princess Royal University Hospital, part of King’s, highlighted: “There is a national shortage of colonoscopy and endoscopy capacity, and so we can ill afford to waste appointments. It is vital that each and every appointment slot is utilised effectively. The majority of cancers are diagnosed through colonoscopies; it’s an incredibly important and life-saving procedure, which is used to diagnose many patient conditions, so it needs to be used as efficiently and time-sensitively as possible.”

Improvement

Kings wanted to address this issue and maximise the number of appointments that are successful first time. 

The hospital teamed up with Barking, Havering and Redbridge University Hospitals Trust to secure funding from NHSX (now NHS Digital) then used this support to work with Healthcare Communications, as they developed a system where patients on the waiting list now receive a number of SMS reminders. At 14 days in advance of their appointment, patients receive a standard reminder. This is followed by reminders at seven days, three days, 48 hours, and then 24 or 22 ahead of their patients scan time. Each reminder, contains vital information and video instructions, re-enforcing the importance of following pre-procedure directions correctly and ensuring patients are prepared for their appointments and are on time. Additionally, those who opt out of SMS reminders are offered paper letters in the post. 

Outcomes

Once this was implemented, clinicians reported a 28 per cent drop in failed colonoscopies due to poor bowel prep, falling from 6.25 per cent to 4.49 per cent. This resulted in savings of £130,000 a year from a reduction in failed appointments and also led to freed-up capacity. 

85 per cent of patients reported that they found the prep reminders helpful, and they help to make sure patients don’t have to go through colonoscopies and bowel prep more than once.