P0735 - Skip a Step, Not a Screening: Improving Hepatocellular Carcinoma Screening Rates at the Atlanta VA Hepatology Clinic

Marc A. Hersh, MD¹, Alan G. Noll, MD¹, Dharma Sunjaya, MD¹, Cesar Taborda, MD¹, Anand S. Shah, MD^2
1Emory University School of Medicine, Atlanta, GA; ²Emory University School of Medicine, Decatur, GA

Introduction: Screening for hepatocellular carcinoma (HCC) in patients with cirrhosis with abdominal imaging every six months is recommended as they have an annual incidence of 1-5%. Ultrasound (US) is a cost effective and non-invasive modality used to screen for HCC. Among veterans following at the Atlanta VA hepatology clinic for cirrhosis or advanced fibrosis, we found that 49.3% (257/501) of veterans were up-to-date with HCC screening as of October 2020. Our aim was to increase the % of veterans up-to-date with HCC screening by 15% over the next 6 months with a short term aim to increase the rate of US scheduled within 14 days of order placement.

Methods: A Plan, Do, Study, Act (PDSA) cycle was developed to understand lapses in HCC screening. Patients seen via telephone or in person at the Liver clinic at the Atlanta VA with a known diagnosis of cirrhosis from October 2020 to February 2021 were included. A process map, cause and effect diagram and a pareto chart were completed to better understand the major causes of lapsed screening. After identifying the intervention, a run chart was used to track rates of scheduled US within 14 days of the order placement compared to rates of other imaging modalities scheduled.

Results: Our analysis found that the majority ( >55%) of lapsed HCC screenings was secondary to the Radiology department being unable to reach the veteran to schedule the exam. A process map demonstrated that US do not require an attending radiologist review prior to scheduling, so a delay could be avoided if the veteran was able to schedule the exam immediately following the clinic visit. Our intervention consisted of choosing US over cross-sectional imaging unless otherwise indicated and providing patients the contact information for them to call and schedule the imaging following the visit. The proportion of US ordered for HCC screening increased from 32% to 62% and the rate of exams scheduled within 14 days of order placement improved from a median rate of 28% to 39% following our intervention.

Discussion: Our quality improvement project identified various barriers involved in ordering and successfully completing HCC screening at the Atlanta VA. Our intervention focused on the ease in which an US can be scheduled instead of cross-sectional imaging and showed a sustained improvement in the median rates of scheduling. Additional PDSA cycles addressing US order entry and cancellations, and longitudinal data is needed to assess our long term aim of improving up-to-date HCC screenings.




Disclosures:


Marc A. Hersh, MD¹, Alan G. Noll, MD¹, Dharma Sunjaya, MD¹, Cesar Taborda, MD¹, Anand S. Shah, MD². P0735 - Skip a Step, Not a Screening: Improving Hepatocellular Carcinoma Screening Rates at the Atlanta VA Hepatology Clinic, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.