UT Health San Antonio San Antonio, TX, United States
Archish Kataria, MD1, James Gnecco, DO2, Eugene Stolow, MD, MPH1, Allison Harrington, MD1, Brenda Briones, MD1, Harsh Patel, MD1, Juan Echavarria, MD2, Randy P. Wright, MD1 1UT Health San Antonio, San Antonio, TX; 2University of Texas Health Science Center at San Antonio, San Antonio, TX
Introduction: Multiple society guidelines have recommended annual fecal immunochemical test (FIT) to screen for colorectal cancer (CRC) in average-risk individuals. Use of FIT for evaluation of iron deficiency anemia (IDA) or suspected gastrointestinal (GI) bleeding shows poor performance characteristics, and is not supported by guidelines. Yet, we see increasing number of FIT ordered in the hospital setting for indications other than CRC screening. This results in unnecessary costs (~$80/FIT) and has not been shown to alter management. The aim of our quality improvement study was to reduce the utilization of inpatient FIT by means of educating physicians from different specialties.
Methods: We queried all FIT done over 2 months at our institution. Only patients aged >18 years were included in the study. Pre-intervention data regarding test indication, ordering specialty, presence of IDA and overt bleeding on exam (Figure 1) were collected via retrospective chart review. For our educational intervention, posters highlighting guideline based use of FIT were distributed to departments with the highest prevalence of inappropriate use, and a lecture was given to the Internal Medicine residency program to improve knowledge gaps regarding the use of FIT. Post-intervention, a review of variables of interest over 3 months was conducted to determine if our intervention improved appropriate utilization of FIT.
Results: 28 of 42 pre-intervention FIT ordered over a 60-day period and 34 of 51 post-intervention FIT ordered over a 90-day period were included in review. Pre-intervention FIT orders averaged 0.47 tests/day. Post-intervention, this number decreased to 0.38 tests/day. Regarding use of FIT per specialty, there was decrease seen in Internal and Family medicine departments, no change observed in Emergency medicine specialty, while the number of tests ordered increased in specialties not included in the educational intervention.
Discussion: This project helped spread awareness regarding the indications for FIT and decreased the average daily utilization and associated cost of this test. Annual FIT for CRC screening is supported by multiple guidelines. The use of FIT for indications like IDA evaluation, suspected occult/overt GI bleeding and/or GI symptoms should be avoided due to increased numbers of false positives/negatives. When used for diagnostic purposes, FIT result should not guide further endoscopic or medical management.In the future, we can involve more departments to further reduce knowledge gaps.
Figure: Figure 1: Pre-Intervention
Archish Kataria indicated no relevant financial relationships.
James Gnecco indicated no relevant financial relationships.
Eugene Stolow indicated no relevant financial relationships.
Allison Harrington indicated no relevant financial relationships.
Brenda Briones indicated no relevant financial relationships.
Harsh Patel indicated no relevant financial relationships.
Juan Echavarria indicated no relevant financial relationships.
Randy Wright indicated no relevant financial relationships.
Archish Kataria, MD1, James Gnecco, DO2, Eugene Stolow, MD, MPH1, Allison Harrington, MD1, Brenda Briones, MD1, Harsh Patel, MD1, Juan Echavarria, MD2, Randy P. Wright, MD1. P0273 - Reducing the Inappropriate Use of Fecal Immunochemical Testing (FIT) in the Hospital Setting, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.