P1205 - Examining the Impact of a GI Hospitalist Model on the Outcomes of Double Balloon Enteroscopy: A Single Center Retrospective Study

Award: Presidential Poster Award

Shaili Babbar, MD¹, Melissa Latorre, MD^2
1New York University Langone, New York, NY; ²NYU Langone Health, New York, NY

Introduction: The hospitalist model, which has been adopted by medical subspecialties like gastroenterology (GI), has been shown to improve patient outcomes, quality metrics, and hospital costs. A GI hospitalist (GIH) is a physician who practices in the inpatient setting, performing consultations and endoscopic procedures. The GIH model encourages timely patient care and better management of GI emergencies due to the GIH’s onsite presence and expertise in treating complex hospitalized patients. Since obscure small bowel bleeding is so common in the inpatient setting, GIHs are adept at advancing care to prompt small bowel evaluation. Thus, it is fitting for GIHs to learn techniques like video capsule endoscopy (VCE) and double balloon enteroscopy (DBE). This study will be the first to explore how implementing a GIH model and providing the GIH with training in VCE and DBE can improve the outcomes of patients with small bowel pathology.

Methods: We performed a retrospective single center study of patients who received an inpatient DBE at an academic quaternary care medical center before and after initiation of a GIH model and credentialing of a GIH in DBE. We collected data from the 39 months prior to a GIH performing this procedure (September 2015 through December 2018) and from the 39 months after the GIH obtaining competency (January 2019 through March 2022). We compared outcomes, including diagnostic and therapeutic yields, as well as time-to-procedure, length of stay (LOS), and discharges before noon (DBN).

Results: A total of 175 inpatient DBEs were included in the analysis, with 71 performed before a GIH and 104 performed by a GIH. There was a 46.5% increase in the number of DBEs performed in the time period with a GIH. The diagnostic yield increased from 56.3% to 74.0% (OR 2.2, 95% CI 1.2-4.2), and the proportion of DBEs with a therapeutic intervention increased from 38.0% to 65.4% (OR 3.1, 95% CI 1.4-7.0). The total procedure time increased from 77.8 minutes to 96.4 minutes (p< 0.05) with a GIH. Though not significant, a trend towards reduced LOS and time from admission-to-procedure was also observed.

Discussion: After a GIH was trained to perform VCEs and DBEs, we observed improved patient outcomes. Having a GIH perform inpatient DBEs was associated with an increased number of procedures, duration of procedures, diagnostic yield, and therapeutic interventions. The onsite presence of a GIH with competency in DBE improves the care of hospitalized patients with small bowel pathology.



Disclosures:


Shaili Babbar, MD¹, Melissa Latorre, MD². P1205 - Examining the Impact of a GI Hospitalist Model on the Outcomes of Double Balloon Enteroscopy: A Single Center Retrospective Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.