Reducing Colonoscopy Cancelations and Increasing Efficiency

August 10, 2022
Posted in Patient Engagement

Article Summary

Swedish Health Services utilized the Twistle by Health Catalyst patient engagement software to deploy a communication pathway that guides patients throughout their colonoscopy experience.


Featured Outcomes
  • 44 percent decrease in cancelations.
  • 99.8 percent patient adoption.
  • 96 percent rated Twistle helpful in follow up survey.


Swedish Health Services provides over 7,000 colonoscopies annually at their Issaquah location. While their cancelation rate of 7.57 percent is below the national average, they believed that there was still an opportunity to optimize resource utilization, improve appointment availability, and decrease average patient wait times.

Swedish sought to ensure that patients schedule their appointment in accordance with national cancer screening guidelines, adhere to colonoscopy preparation protocols, communicate issues that would prevent a successful test as early as possible, and arrive on-time.

Reducing the number of no-shows and cancelations had the potential to impact over 500 patients and increase the availability of this potentially life-saving screening procedure.


Swedish engaged Twistle by Health Catalyst in May of 2017 to deploy a 14-step communication pathway that guides patients throughout their colonoscopy experience. Secure messages provide gentle nudges to keep patients on track, confirming appointments, ensuring proper bowel preparations, and promoting timely arrival through reminders, educational videos and coaching.

The colonoscopy pathway provides important guidance from reminders about why the procedure is necessary, to what to expect in those potentially stressful final steps of preparation.

Appointment confirmation messages are delivered well in advance of the scheduled procedure, and check-ins throughout the preparation process help identify cancelation risk while there is still time to backfill the schedule.

“Our patients really like the coaching and support they receive throughout the bowel prep process, and we appreciate having enough advanced notification about cancelations to be able to service our waiting list.”

Dr. Amir Bastawrous, MBA


Swedish launched the Twistle colonoscopy pathway at its Issaquah location. Over the course of the pilot, 720 participated in this program, accessing messages and replying when appropriate.
At the conclusion of the pilot, the program was expanded across all Swedish facilities to become the standard of care.

“This app really helped me get through a terrible experience – getting ready for a colonoscopy and drinking the meds. It was like having a friend beside me helping me along the way. I love this app and highly recommend it!”

Swedish Colonoscopy Patient


Swedish recognized an opportunity to impact patients who may be at risk for developing colon cancer and help patients through a potentially overwhelming experience, realizing great results:

  • By the end of 2017, the number of no shows and late cancelations decreased by 44 percent in the Twistle cohort of patients. Proactive communication ensures that when cancelations are unavoidable, they are made with enough time to backfill the vacated appointment.
  • 99.8 percent of patients adopted the technology.
  • Throughout the pilot period, patients read or responded to 78 percent of all messages.


Swedish successfully decreased their colonoscopy no-show and cancelation rates, improving their ability to screen more patients and improve operational efficiencies. They continue to iterate and optimize the pathway to further improve service.
In light of recent guidance from the U.S. Preventive Services Task Force recommending that screening for colorectal cancer should start at age 45, not 50, there may be even more value in maximizing Swedish’s capacity to provide colonoscopies.

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