C0171 - Inappropriate Utilization of Fecal Immunochemical Test (FIT) in Inpatient and Emergency Setting and Its Impact on Patient Outcomes: A Quality Improvement Project

Talia F. Malik, MD¹, Shreya Desai, MD¹, Shubham Agarwal, MD¹, Javairia Quraishi, MD¹, Ammar Ahmed, MD¹, David You, MD^2
1Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL; ²Captain James A. Lovell Federal Health Care Center, North Chicago, IL

Introduction: Fecal immunochemical test (FIT) uses antibodies to detect blood in stool and is indicated for colorectal cancer (CRC) screening. Positive FIT followed by colonoscopy significantly reduces mortality and morbidity associated with CRC. However, inappropriate utilization of FIT testing can lead to unnecessary endoscopic evaluation. We evaluated its utilization in inpatient and emergency settings to determine the outcomes and impact on patient care.

Methods: A retrospective observational study was conducted and electronic medical records of patients with a positive FIT between November 2020 to March 2021 at a large community-based hospital were reviewed. The primary outcome was proportion of FIT tests ordered for non-screening related indications. Secondary outcomes were gastroenterology (GI) referral, follow-up endoscopic evaluation, time to colonoscopy, and colonoscopy findings. Data was analyzed using descriptive statistics.

Results: During the 5 month period, 45 patients had a positive FIT in the hospital setting. Among these patients 41 (91.1%) were male, and the median age was 58 years (Table 1). The majority of tests were ordered by the emergency department (75.5%, n=34) followed by the general medical floor (20%, n=9) and intensive care unit (4.44%, n=2). The most common indication for ordering the test was gastrointestinal bleed (55.6%, n=25) and only 6 (13.3%) were ordered for CRC screening (Figure 1). Among patients with a positive FIT, 31 (68.9%) were referred to GI, 11 (24.4%) had an esophagogastroduodenoscopy (EGD), 21 (46.7%) had a colonoscopy and 10 (22.2%) had both (EGD and colonoscopy) within 12 months. Among those who underwent a colonoscopy the median time to colonoscopy was 9 days. Colonoscopy showed normal findings in most patients (52.4%, n=11), followed by adenoma detection in 5 patients (23.8%). No CRC was diagnosed in this cohort.

Discussion: Our study showed FIT was routinely ordered in the hospital setting for indications other than CRC screening and less than half of the patients received follow-up colonoscopy after a positive FIT. This can be attributed to a poor understanding of the test’s purpose. Inappropriate FIT testing leads to unnecessary endoscopic evaluation and adds significant strain on healthcare resource utilization. We plan to implement measures to reduce this practice in these settings and improve colonoscopy completion rates after a positive FIT.




Disclosures:


Talia F. Malik, MD¹, Shreya Desai, MD¹, Shubham Agarwal, MD¹, Javairia Quraishi, MD¹, Ammar Ahmed, MD¹, David You, MD². C0171 - Inappropriate Utilization of Fecal Immunochemical Test (FIT) in Inpatient and Emergency Setting and Its Impact on Patient Outcomes: A Quality Improvement Project, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.