“Constipation affects nearly 4 million Americans and accounts for about $7 billion in health care expenditures in the U.S. alone each year,” states Dr. Jonathan Golightly, director of disease-specific care certification at the Joint Commission. “Some of the complications can include hemorrhoids, anal fissures, rectal prolapse, fecal impaction, and even death. This is a very serious health issue indeed.”
To obtain the certification, hospitals need to maintain door-to-BM times under 60 minutes. This will be facilitated by the creation of a specialized endoscopy suite called the Constipation Resolution And Procedural Lab (CRAP Lab for short). Here a dedicated team of professionals will be able to quickly deliver a variety of enemas or perform digital disimpaction if needed.
The Joint Commission recommends the creation of a new “Code Brown” emergency overhead designation, whereby staff anywhere in the hospital can rapidly notify the CRAP Lab of the need for intervention. Upon activation of the Code Brown team, a radiology tech will obtain a STAT acute abdominal X-ray within 10 minutes of arrival (”door” time), then the patient should be transported to the CRAP Lab within 25 minutes of arrival.
Once in the CRAP Lab, a specially educated RN, preferably one with small fingers, will first administer a milk & molasses enema (or “M&M”). If no BM occurs within 15 minutes, the RN will then attempt digital disimpaction. If unsuccessful, endoscopic decompression should begin immediately, with an end goal of achieving defecation within 60 minutes of arrival.
Hospitals are already vying for the new title, which would enable EMS to bring constipated patients quickly to a facility prepared for rapid bowel evacuation, thereby boosting potential revenues.