University of South Florida Morsani College of Medicine Tampa, FL, United States
Sonya Bhaskar, MD1, Shruthi Narasimha, MD1, Jeffrey Cummings, MD2, Roger Nehaul, MD2 1University of South Florida Morsani College of Medicine, Tampa, FL; 2James A. Haley VA Hospital, Tampa, FL
Introduction: The fecal immunochemical test (FIT) is a validated test for colorectal cancer screening for average risk individuals over the age of 45 as per the latest guidelines from the United States Preventative Task Force1. Using antibody-hemoglobin complexes, the test identifies human hemoglobin in a stool sample with a sensitivity of 74% and specificity of 94%1, 2. A positive FIT test requires a follow-up colonoscopy for the detection and removal of pre-cancerous lesions. During the fiscal year (FY) 2020, 62% of returned FIT kits at the Veterans Administration Hospital were sent back incorrectly. This inefficiency led to increased cost/wasted product, delay in cancer detection, and dissatisfaction for patients and providers alike. Furthermore, the COVID-19 pandemic urged social distancing measures, which increase FIT kit usage since in-person colonoscopies were deferred.
Methods: The ambulatory quality improvement project sought out root causes for the incorrectly returned FITs and proposed PDSA cycles based on a series of approved action plans. The multi-department team composed of individuals from lab, nursing, administrative staff, and primary care came together virtually and discovered 6 major root causes. The 80/20 rule was applied to our pareto chart of root concerns and a frequency vs. risk chart was made to highlight our major problems.
Our assessment showed that lack of written collection date was the biggest issue and thus a PICK chart was assembled to prioritize our future solutions. Our multi-pronged PDSA (Plan, Do, Study, Act) cycle attempted to set up redundant patient reminders, centralize the FIT dispersal process and make the patient-FIT interface more user-friendly. All our PDSA solutions were implemented over the course of 4 months.
Results: Preliminary data has shown that the average percentage of incorrectly returned FITs due to lack of written collection date has decreased by 38.56% as of May 2021.
Discussion: As with any quality improvement process, an overhaul in process can bring up new issues. Due to frequent assessments through this project, we were able to troubleshoot a number of human factor engineering issues that arose between staff and FIT kits. Our aim is to continue these efforts throughout FY 2021 and attempt to improve our FIT screening capability at the VA.
Figure: Percentage of Monthly FITS Incorrectly Returned due to "No Written Collection Date"
Sonya Bhaskar indicated no relevant financial relationships.
Shruthi Narasimha indicated no relevant financial relationships.
Jeffrey Cummings indicated no relevant financial relationships.
Roger Nehaul indicated no relevant financial relationships.
Sonya Bhaskar, MD1, Shruthi Narasimha, MD1, Jeffrey Cummings, MD2, Roger Nehaul, MD2. P1323 - The FIT Initiative: A VA Quality Improvement Initiative to Improve Colorectal Cancer Screening, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.