Three Minutes of Verbal Instructions Improved Bowel Preparation in Mobile Inpatients

Clinicians everywhere struggle with colonoscopy bowel preparation in inpatients. In a randomized trial performed in 4 cities, 300 patients (180 mobile and 120 bedridden) received either 3 minutes of verbal instructions from an investigator or usual care, which included written instructions on an informed consent leaflet and typical information provided by the hospital nursing staff. The 3-minute verbal instructions covered the value of adequate preparation, the bowel preparation procedure, diet during the preparation period, the cathartics schedule, the necessity of drinking the entire preparation solution and additional clear fluids, and possible side effects. The preparation was 2 days of a low-fiber diet, followed by clear liquids the day before colonoscopy and 4 liters of polyethylene glycol-electrolyte lavage solution. 

Key results:

• In the intention-to-treat analysis, the rate of adequate bowel preparation (the primary endpoint for the study) was 60.4% in the intervention group versus 54.3% in the standard-of-care group (P=.29). 
• In the per-protocol (PP) analysis, the difference was also not significant (69.8% vs 62.1%; P=.19).
• In the PP analysis of mobile patients, the rate of adequate preparation was higher in the intervention group than the standard-of-care group (81.5% vs 66.3%; P=.03).
• More patients in the intervention group achieved good or excellent preparation (58.1% vs 43.2%; P=.02).
• An ASA score ≥3 and same-day preparation administration were prognostic factors for inadequate preparation. If both were present, the odds ratio for inadequate preparation was 55.6.