Health Services Research & Development

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Cheng C, Ganz DA, Chang ET, Huynh A, De Peralta S. Reducing Rejected Fecal Immunochemical Tests Received in the Laboratory for Colorectal Cancer Screening. Journal for healthcare quality : official publication of the National Association for Healthcare Quality. 2019 Mar 1; 41(2):75-82.
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Abstract: BACKGROUND: Colorectal cancer (CRC) screening decreases CRC incidence; however, many patients are not successfully screened. PURPOSE: To improve screening rates at our institution by decreasing the rate of rejected fecal immunochemical tests (FITs), a means of CRC screening, from 28.6% to <10% by December 2017. METHODS: Specimens were rejected for the following reasons: expired specimen, lack of recorded collection date/time, lack of physician orders, incomplete patient information, and illegible handwriting. Multidisciplinary teams devised the following interventions: FIT envelope reminder stickers, automated FIT patient reminder phone calls, a laboratory standard operating procedure, an accessioning process at satellite laboratories, revisions to a clinical reminder when offering FIT, and provision of FIT-compatible printers to clinics. RESULTS: Total specimens received each month ranged from 647 to 970. Fecal immunochemical test rejection rates fell from 28.6% in June 2017 to 6.9% in December 2017 with a statistically significant decrease (p-value = .015) between the intervention period (May 2017-October 2017) and the postintervention period (November 2017-May 2018). CONCLUSIONS: Targeted interventions with stakeholder involvement are essential in reducing the rejection rate. IMPLICATIONS: The decreased rejection rate saves resources by decreasing the need to rescreen patients whose specimens were rejected, and may improve CRC screening rates.