Table 1.

Intervention to Increase Colonoscopy at Lincoln¹⁰

Interventions	Period	Description of intervention	Effect of intervention
Patient navigator	May 2003	Patient Navigators	(1) Dramatic and sustained decline in the broken appointment rates for both screening and diagnostic colonoscopy (from 67% in May of 2003 to 5% in June of 2003)
		(1) assisted patients in completing paperwork for pre- admission testing
		(2) schedule appointments,
		(3) and provide appointment reminder immediately prior to the scheduled appointments
		(4) facilitate referrals either through the GI or colorectal clinic	(2) Likelihood of keeping the appointment for colonoscopy after the patient navigator intervention increased by nearly threefold
Direct endoscopic referral (DERS)	August 2003	DERS	(1) The rates of screening colonoscopies increased from 56.8 per month to 119 per month
		(1) Allows referral of patients directly to pre admission testing for the necessary clearance and scheduling for the colonoscopy appointment
		(2) bypasses the need for a medical clearance appointment at either GI or colorectal clinic
		(3) reducing the wait time between scheduling and receipt of colonoscopy
GI Suite enhancement	September 2003	GI suite enhancements as follows:	(1) The screening colonoscopy coverage provided by this facility among persons aged 50 and over in surrounding zip codes increased from 5.2% to 15.6%
		(1) addition of more equipment such as colonoscopes and video processors
		(2) colonoscope cleaning was moved from the basement to the GI suite resulting in faster turn around time and less potential for damage to the colonoscopies
		(3) GI suite recovery areas were redesigned such that one RN could now monitor at least 4 patients
		(4) an anesthesiologist performs the required moderate sedation and completes all paperwork (reducing the procedure time by an estimated 10 to 15 minutes per case)