eP385 - Improvement in Quality of Screening Colonoscopies Performed by General Surgery Residents After Protocol Standardization

Purpose/Background: Colorectal cancer is the second leading cause of cancer-related death. Current guidelines recommend colorectal cancer screening for average-risk adults aged 45-75, with colonoscopy as the gold standard of several structural and stool-based options. The ACGME requires general surgery residents to perform a minimum of 50 colonoscopies. Our prior observational study evaluated the quality of screening colonoscopies performed by surgical residents in accordance with the American Society for Gastrointestinal Endoscopy (ASGE) quality indicators. Our residents failed to meet the target goal for 4 of 6 metrics including adenoma detection rate (ADR). We implemented a quality improvement initiative for resident-performed colonoscopies at our institution. The objective of our study is to evaluate the quality of screening colonoscopies performed by surgical residents for patients from the resident-run general surgery clinic after the implementation of a standardized protocol.Methods/Interventions: This is a follow-up retrospective observational study of screening colonoscopies performed from 5/16/2021 to 7/24/2023. Following our initial study in May of 2021, we implemented a standardized colonoscopy screening note template and standardized bowel preparation regimen. We further instituted mandatory documentation of cecum visualization, quality of preparation, and withdrawal time. Colonoscopies were performed under the supervision of a single colorectal surgeon. Data were obtained through review of gGastro records and chart review. Clinical variables collected were patient age, sex, BMI, and other demographics. Procedural variables included resident level, quality of preparation, cecal intubation, time to cecum, withdrawal time, and ADR. Patients were excluded for a personal history of inflammatory bowel disease, prior colon surgery, and family history of colon cancer. Diagnostic and cancer surveillance colonoscopies were not included. ADR was calculated as the percentage of examinations with at least one adenoma detected.Results/Outcomes: Twenty-nine patients meeting inclusion criteria underwent screening colonoscopies by general surgery residents. The results for six quality indicators are shown in Table 1. General surgery residents met the target goal set by the ASGE for 5 of 6 quality indicators. We did not meet the goal for measurement of withdrawal time, but our rate improved from our initial evaluation.Conclusion/

Discussion: This quality improvement program, which entailed standardization of protocol, resulted in improvement of all quality metrics and met 5 of 6 target goals. The greatest limitation of this study is its small population size. We will continue to evaluate our colonoscopy program prospectively and implement additional changes to improve patient compliance and resident performance and minimize loss to follow-up.Table 1.Colonoscopy Quality Indicators Pre- and Post-intervention