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Oral sodium phosphate solution (OSPS) has been associated with acute renal failure when used as a bowel preparation for colonoscopy.To determine whether gastroenterologists in Indiana follow recent recommendations for safe and effective use of colonoscopy.A survey of gastroenterologists in Indiana performed in mid-2006. Written instruction to patients were obtained and reviewed.We received responses from 97.5% of Indiana gastroenterologists, of whom 80% reported using OSPS. All using OSPS forwarded their written instructions. None exceeded the recommended two 45 mL doses in their written instructions. Although separation of the two 45 mL doses by at least 6 to 12 hours is recommended, 35% of physicians prescribed the 2 doses at intervals less than 6 hours. Only 9.7% gave specific instructions for volumes of fluid to be taken before the first dose. Fluid prescriptions during the preparation were often suboptimal according to current recommendations. Less than 25% of physicians followed the recommendation to use carbohydrate-electrolyte solutions for hydration.Gastroenterologists in Indiana in mid-2006 uniformly followed recommendations for maximum doses of OSPS, but recommended intervals for the doses and gave hydration instructions that often did not follow current recommendations.