Hospitalized patients undergo many tests which can reveal medical issues unrelated to their primary reason for hospitalization. This can lead to consultant evaluations which are necessary, although often not urgent. We evaluated one institution's practice of hospitalized patients requiring non-urgent gastroenterology (GI) procedures. The standard was for patients to either have an inpatient procedure or follow up in clinic after discharge to be scheduled for a procedure, often weeks to months after the initial hospitalization. We instituted a new protocol for scheduling hospitalized patients directly for outpatient procedures within two weeks of discharge.
A protocol was developed for GI fellows consulting on inpatients with incidentally discovered heme positive stool or non-life threatening anemia at New York-Presbyterian Queens Hospital to evaluate the urgency of a GI procedure. If non-urgent, the fellow notified the patient navigators who then reviewed the pre-procedure instructions with the patient and scheduled the procedure for within two weeks of discharge. Patients returned for their procedure and subsequently were seen in the clinic for follow up.
17 patients were included with 6 procedures completed. Of the 11 patients whose procedures were not completed, 7 were “no shows”, 3 had medical contraindications and 1 insurance authorization was not obtained. On average, each inpatient procedure directly costs the hospital $1,200. Conversely, each outpatient procedure yields $800. In sum, this protocol resulted in approximately $25,200 in total savings/credit for the institution.
Incidental medical problems discovered during a patient's hospitalization can have downstream effects including additional procedures. Without a system to timely complete these procedures outpatient, there is pressure to do so inpatient. This can decrease patient satisfaction, increase length of stay, strain the endoscopy unit, and cause financial loss. We instituted a protocol to ensure hospitalized patients requiring non-urgent GI procedures were directly scheduled for that procedure within two weeks of discharge without the delay of a clinic visit before scheduling. This lead to 17 procedures avoided in the hospital, a direct hospital savings of over $25,000. Hurdles included patients lost to follow up and delays with insurance pre-authorization. With continued refinement, we hope to improve this process to create a better system for patients, providers, and the hospital.