Narasimha Shruthi, Chauhan Sukhjinder, Nehaul Roger, Cummings Jeffrey, Wright Susan, Patterson Alexis, Mullins Raymond, Messina William, Zilka Brian, Kraus Ana
James A. Haley Veterans Affairs Medical Center, Tampa, Florida.
HCA Sunrise Health Graduate Medical Education Consortium, Las Vegas, Nevada.
Fed Pract. 2024 May;41(Suppl 2):S29-S37. doi: 10.12788/fp.0455. Epub 2024 May 15.
Colonoscopy is a first-line method for colorectal cancer (CRC) screening. However, cost-effective noninvasive tests, such as high-sensitivity guaiac-based fecal occult blood test (gFOBT) and fecal immunochemical test (FIT), are also used. The COVID-19 pandemic had a substantial negative impact on CRC screening rates. The James A. Haley Veterans Affairs Hospital (JAHVAH) continued socially distant CRC screening using FITs, but encountered inefficiencies due to high rates of incorrectly collected FIT samples. A quality improvement (QI) project was conducted to increase correctly collected and testable FIT kits upon initial laboratory submission.
The ambulatory QI project sought out root causes for incorrectly returned FITs and proposed Plan-Do-Study-Act (PDSA) cycles based on a series of approved action plans. A multidisciplinary team of laboratory, nursing, administrative, and primary care staff worked together to discover 6 major root causes. Our multipronged PDSA cycle attempted to set up redundant patient reminders, centralize the FIT dispersal process, and make the patient-FIT interface more user-friendly. All PDSA solutions were implemented over 4 months. Lack of collection date was the most common reason for incorrectly returned FIT kits and the focus of PDSA improvements. The rate of FITs with missing collection dates dropped from 24% prior to PDSA to 14% in April 2021. The rate of correctly returned FIT kits rose from 38% before the project to 72% afterwards, surpassing the 20% improvement goal.
FIT is a useful method for CRC screening that can be particularly helpful when in-person visits are limited, as seen during the COVID-19 pandemic. The increase in demand for FITs during the pandemic revealed process deficiencies and gave JAHVAH an opportunity to improve workflow.
结肠镜检查是结直肠癌（CRC）筛查的一线方法。然而，也会使用具有成本效益的非侵入性检测方法，如高灵敏度愈创木脂粪便潜血试验（gFOBT）和粪便免疫化学检测（FIT）。2019冠状病毒病大流行对CRC筛查率产生了重大负面影响。詹姆斯·A·海利退伍军人事务医院（JAHVAH）继续使用FIT进行社交距离CRC筛查，但由于FIT样本采集错误率高而效率低下。开展了一项质量改进（QI）项目，以提高初次提交实验室时正确采集和可检测的FIT试剂盒数量。
门诊QI项目找出了FIT返回错误的根本原因，并根据一系列批准的行动计划提出了计划-实施-研究-改进（PDSA）循环。由实验室、护理、行政和初级护理人员组成的多学科团队共同努力，发现了6个主要根本原因。我们的多管齐下的PDSA循环试图设置冗余的患者提醒，集中FIT分发过程，并使患者与FIT的界面更加用户友好。所有PDSA解决方案在4个月内实施。缺少采集日期是FIT试剂盒返回错误的最常见原因，也是PDSA改进的重点。缺少采集日期的FIT比例从PDSA之前的24%降至2021年4月的14%。正确返回的FIT试剂盒比例从项目前的38%升至之后的72%，超过了20%的改进目标。
FIT是CRC筛查的一种有用方法，在面对面就诊受限的情况下（如在2019冠状病毒病大流行期间所见）可能特别有帮助。大流行期间对FIT需求的增加揭示了流程缺陷，并给了JAHVAH改进工作流程的机会。
