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Inpatient endoscopy delays resulted in extended hospital stays and readmissions within a month, a retrospective study found.

Among over 4,000 inpatients treated at a tertiary care center and requiring endoscopy, 19.3% experienced delays, adding an average hospital stay extension of 2 days, and 19.7% were readmitted within 30 days, reported Dennis Yang, MD, and colleagues from the University of Florida in Gainesville.

The most commonly reported cause for endoscopy delay was poor bowel preparation (27%), followed by the lack of endoscopic unit availability or personnel (24.4%), according to the findings in .

Independent predictors for endoscopy delay in inpatients included colonoscopy (OR 1.50, 95% CI 1.27-1.77), being on contact isolation (OR 1.38, 95% CI 1.09-1.75), and use of antithrombotics (OR 1.30, CI 1.08-1.57), they noted.

Calvin Lee, MD, of Long Island Jewish Medical Center in New York City, who was not involved with the research, said that from a systems perspective, the study highlights the benefits of adjusting endoscopic capacity to match the needs of patients and providers.

"The appropriate timing of inpatient endoscopic procedures is important to the efficacy and safety of patient care, with an impact on length of stay and readmission rates," Lee told MedPage Today.

"Unanticipated delays of procedures can be caused by patient and system factors. Patient medical complexity is most likely the underlying reason for procedural delays and hospital readmissions," he added.

Coordinating endoscopies for inpatients is challenging due to multiple factors, and delays can increase costs and result in extended hospital stays. Furthermore, longer lengths of stay (LOS) increase patients' risk for nosocomial infections. To provide inpatients with high-quality healthcare, timely inpatient endoscopies are critical, the authors said.

"Most research on preps is on ambulant outpatients. Hospital endoscopy units need to be flexible to accommodate the unpredictability of inpatient cases which, by definition, are unscheduled. It is clear that resolving these challenges will significantly shorten LOS and could reduce readmission rates," Eamonn Quigley, MD, of Houston Methodist Hospital, told MedPage Today.

"Results come as little surprise and emphasize the importance of understanding the challenges that relate to inpatient endoscopy. Inpatient preps are an issue -- we need more research on what it takes to consistently produce good preps on inpatients," added Quigley, who was not involved in this study.

Yang and colleagues sought to conduct a comprehensive analysis of several factors in an attempt to mitigate inpatient endoscopy delay and allow patients quality healthcare access, as knowledge of such data can be useful in reducing the burden on healthcare systems, they wrote.

Kondal Kyanam Kabir Baig, MD, of the University of Alabama at Birmingham's Basil I. Hirschowitz Endoscopic Center of Excellence, said the study confirms anecdotal experiences regarding delay in inpatient endoscopy.

"The authors also make excellent evidence-based recommendations on correcting these issues. I, however, feel that similar studies in varied practice settings, such as other large university hospitals and community hospitals may provide useful insight," Kyanam Kabir Baig, who was also not involved with the research, told MedPage Today.

Yang's group examined data from 4,239 inpatients in a tertiary care center whose documented endoscopy data was assessed from Nov. 1, 2017 to Nov. 31, 2019. The primary goals of this study were to assess inpatient endoscopy delay frequency in a tertiary care center, including effects on 30-day hospital readmission and hospital LOS. Authors also sought to identify predictors for inpatient endoscopy delay.

The average age of patients was 58 and just over half of all participants were women. The most common reasons for gastrointestinal-indicated admissions among patients were lower GI bleeding (20.8%), abdominal pain (18.9%), and anemia (6.8%). Just over half of endoscopic procedures performed on inpatients were upper endoscopy procedures.

Patients who experienced inpatient endoscopy delay were older, more were women, and they were more commonly on antithrombotic medications or opioids, and on contact-isolation precaution measures. However, those admitted to a medicine service dedicated to gastrointestinal medicine had a lower chance of experiencing endoscopy delays than compared to inpatients admitted to other services.

The only independent predictor reported for readmission within 30 days was inpatient endoscopy delay (OR 1.22, 95% CI 1.02-1.47, P=0.03). Inpatients who experienced endoscopy delays had a greater chance of not having their cause of disease identified during endoscopy (OR 0.73, 95% CI 0.63-0.86, P<0.001).

"Some factors associated with [inpatient endoscopy delay] cannot be changed, such as patient-related characteristics (age, sex, comorbidities, acuity of illness)," the authors wrote. "In selected cases, outpatient workup, particularly among asymptomatic patients responding to medical therapy, may be appropriate."

Limitations of this study included the unavailability of data for about 25% of study participants due to the retrospective design. Moreover, a total comparative-cost analysis was not performed to measure cost outcomes that inpatient endoscopy delay contributes to healthcare systems.

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