Reasons for Delays in Inpatient Endoscopy in an Underserved Population: A Retrospective Cohort Study

Introduction: The delay of inpatient endoscopic procedures can increase hospital length of stay (LOS), putting patients at risk for complications and increasing hospital costs. A 2017 retrospective nationwide study showed that early endoscopic intervention was associated with lower mortality, shorter LOS, and lower healthcare costs. The objective of this quality improvement project is to identify the underlying reasons that contribute to the delay of inpatient luminal endoscopic procedures - specifically EGD and colonoscopy. Methods: We conducted a retrospective cohort study that included all patients that were admitted to Loma Linda University Health from January 1, 2022 to December 31, 2022. We focused on patients that received a gastroenterology consultation and underwent upper endoscopy or colonoscopy during their admission. Additionally, the time from initial consultation to endoscopy was reviewed, and the reason for the delay (if the endoscopy was performed more than 24 hours after the initial consultation) was identified. Results: Our study included 654 patients, of whom 445 underwent EGD while 209 underwent colonoscopy +/- EGD. Out of the 445 EGD-only cases, 106 (24%) cases were delayed for more than 24 hours. The most common reasons were pending work-up (47%), lack of anesthesia support (25%), and optimization of cardiopulmonary comorbidities (18%, Figure 1). Pending imaging (24%) was the most common reason for a delay due to pending-work-up for EGDs (Table 1). Out of the 209 colonoscopies +/- EGD cases, 111 (53%) cases had delays. The most common reasons were pending work-up (44%), lack of bowel preparation completion (43%), and optimization of cardiopulmonary comorbidities (11%). Pending infectious work-up (57%) was the most common reason for a delay due to pending-work-up for colonoscopies +/- EGDs. Conclusion: Multiple contributing factors led to delays in inpatient upper endoscopy and colonoscopy. The most common modifiable reasons were delays due to pending diagnostic work-up, poor bowel prep, and limited anesthesia resources. Instituting site-specific protocols and clinical pathways to triage, expedite work-up, and coordinate bowel preparation may reduce these delays. These efforts may ultimately improve access to anesthesia services, reduce delays, and shorten hospital LOS.Figure 1.: Bar graph of the different reasons for delay in endoscopic procedures. Table 1. - The type of pending work-up for EGD-only and colonoscopy +/- EGD cases Type of Pending Work-up Number of Cases (EGD only) Number of Cases (Colonoscopy +/- EGD) GI-related infectious work-up 4 (8%) 14 (29%) Cardiac Panel 1 (2%) 0 (0%) Required transfusions 4 (8%) 9 (18%) Imaging 12 (24%) 12 (24%) Non-GI-related infectious work-up 6 (12%) 14 (29%) Non-GI procedure 5 (10%) 1 (2%) Drug Screen 2 (4%) 1 (2%) Monitor 5 (10%) 4 (8%) *Other 4 (8%) 1 (2%) To note, certain patients had multiple types of diagnostic work-up completed. The “Other” category for EGD-only cases includes the following: necrotizing pancreatitis, poor vasculature, and pending Heme/Onc consult. The “Other” category for colonoscopy +/- EGD includes the following: pending Heme/Onc consult and pending OSH records.