Health TrialsbyHealthPanel

Enhanced Ward Rounds for Bowel Preparation Quality in Hospitalized Patients Undergoing Colonoscopy

ConditionsColonoscopyBowel PreparationQuality of Healthcare
Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorLanZhou University

About this trial

Adequate bowel preparation is critical for successful colonoscopy, yet inadequate preparation remains a significant clinical challenge, occurring in 20-30% of procedures. In hospitalized patients undergoing therapeutic colonoscopy, suboptimal preparation leads to increased costs, prolonged hospital stay, and potential procedure cancellation or rescheduling. Current standard care involves resident ward rounds twice daily.

This cluster-randomized crossover trial aims to evaluate whether increasing the frequency of structured resident ward rounds from 2 to 4 times per day can improve bowel preparation quality in hospitalized patients scheduled for therapeutic colonoscopy. The enhanced ward round intervention includes standardized checklist review, medication verification, dietary compliance confirmation, adverse event screening, and timely intervention when needed.

Three hospital wards will be randomly assigned to different sequences of intervention and control periods using a crossover design with washout periods. The primary outcome is adequate bowel preparation quality assessed by Boston Bowel Preparation Scale (BBPS ≥6 with each segment ≥2), evaluated by blinded endoscopists. Secondary outcomes include procedure quality metrics (cecal intubation rate, examination duration), safety endpoints (electrolyte disturbances, aspiration events), health economics measures (length of stay, total costs), and healthcare worker burden (nursing workload, night-time call frequency).

Subgroup analyses will examine intervention effects across age groups, cognitive function levels, prior colonoscopy experience, and comorbidity burden to identify populations most likely to benefit from enhanced monitoring.

This pragmatic trial addresses a clinically relevant question using a real-world implementation strategy designed to minimize workflow disruption. Results will inform evidence-based policies regarding optimal ward round frequency for colonoscopy preparation in hospital settings.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Age ≥18 years

Hospitalized patients (inpatients)

Scheduled for therapeutic colonoscopy (polypectomy, endoscopic mucosal resection [EMR], endoscopic submucosal dissection [ESD], or biopsy for diagnosis)

Time from admission to scheduled colonoscopy ≥48 hours (allowing adequate preparation time)

Disqualifiers

Emergency gastrointestinal conditions: bowel obstruction, acute lower gastrointestinal bleeding requiring urgent intervention, suspected or confirmed perforation

Emergency or same-day colonoscopy (scheduled <24 hours after admission)

History of total colectomy or current colostomy/ileostomy

Severe cognitive impairment (Mini-Cog score 0-1 or MMSE <18) without available caregiver

Trial design

Design model

Crossover

Treatments tested in this trial

  • Enhanced Frequency Ward Rounds with Standardized Intervention Package

    Behavioral

    Increase resident physician ward round frequency from 2 to 4 times per day (adding midday 12:00-13:00 and evening 21:00-22:00 rounds). Each ward round includes standardized checklist-based assessment covering medication adherence, dietary compliance, adverse events, and patient understanding. Duration ≥10 minutes per patient. Electronic documentation with time stamps ensures adherence monitoring.

  • Standard Frequency Ward Rounds

    Behavioral

    Standard care with resident physician ward rounds twice daily at morning (7:30-9:00) and afternoon (15:00-17:00). Routine clinical assessment and verbal confirmation of preparation protocol. Represents current practice standard.

Treatment groups

300 Participants
are divided into 2 treatment groups
Group A: Enhanced Ward Rounds (Intervention)Experimental treatment 1 intervention
Group B: Standard Ward RoundsActive comparator 1 intervention

Trial outcomes

Primary outcomes

1

Adequate Bowel Preparation Rate

Proportion of patients achieving adequate bowel preparation defined as Boston Bowel Preparation Scale (BBPS) total score ≥6 points AND each colonic segment score ≥2 points. BBPS is a validated 0-9 point scale (3 segments × 0-3 points each) assessing preparation quality during colonoscopy. Endoscopist records BBPS score for each segment (right colon, transverse colon, left colon) after cleansing maneuvers during colonoscopy. Adequate preparation requires both: (1) total score ≥6 and (2) no segment with score \<2. Endoscopists remain blinded to patient group assignment.

Time frame
Assessed during colonoscopy procedure (Day 0, examination day)

Secondary outcomes

1

Boston Bowel Preparation Scale (BBPS) Total Score

BBPS total score as continuous variable (range 0-9), with higher scores indicating better preparation quality

Time frame
Assessed during colonoscopy procedure (Day 0)
2

Cecal Intubation Rate

Proportion of procedures achieving successful cecal intubation, confirmed by visualization of ileocecal valve and appendiceal orifice

Time frame
Assessed during colonoscopy procedure (Day 0)
3

Cecal Intubation Time

Time in minutes from scope insertion at anal verge to cecal intubation

Time frame
Assessed during colonoscopy procedure (Day 0)
4

Total Examination Duration

Total procedure time in minutes from scope insertion to scope withdrawal

Time frame
Assessed during colonoscopy procedure (Day 0)

Other outcomes

Sponsors and contacts

Click on the lead sponsor to view all of their trials.

LanZhou University

Lead sponsor

Source ClinicalTrials.gov

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