P4059 - Something Doesn't FIT: Reducing Lab-Rejected FIT Specimens at the Veteran Affairs Medical Center

Elizabeth A. Rowland, MD, MBA¹, Wesley A.. Robertson, MD, MPH, MPA¹, Mohamed Abdelhabib, MD¹, Jolyn Moeller, RN, ACNS-BC², Melinda Somoza, MD², Freya Spielberg, MD, MPH², Anthony Millett, MST², Alvin G. Wong, MD^2
1University of Arizona College of Medicine, Phoenix, AZ; ²Phoenix VA Health Care System, Phoenix, AZ

Introduction: Colorectal cancer (CRC) contributes to significant mortality in the United States, ranking second for cancer-related deaths. The American College of Gastroenterology (ACG) recommends colonoscopy or FIT as the primary CRC screening method. FIT detects CRC with 91% sensitivity and 90% specificity. Repeated annual FIT leads to an 80% CRC detection rate. FIT testing requires patients to collect and submit a stool sample from home using an at-home kit. An initial review of data at the Phoenix Veterans Affairs Medical Center found that, in February 2023 alone, 18% of FIT specimens returned to lab were rejected. A quality improvement task force was convened to further investigate this discrepancy and develop strategies to reduce rejected FIT specimens.

Methods: A representative sample of key stakeholders were engaged to determine procedural inadequacies. This cohort includes laboratory staff, who determine from eligibility criteria if a specimen is acceptable; the primary care provider who orders testing and advises patients; and the patient population, who perform the majority of FIT process.


Results: A Gemba walk revealed a non-standardized process to determine specimen rejection and underlying cause of specimen rejection. Pareto analysis demonstrated a gap between specimen eligibility criteria and Veteran performance. Of the 105 rejected samples in February 2023, 80 samples (76%) were not collected due to absent date of collection identifier. Other common reasons for rejection include improper collection, missing label information, or expired date of submission.

As a result of this finding, executive leadership intervened and temporarily halted ordering of FIT testing pending further process evaluation and demonstrated improvement.


Discussion: Rejected FIT specimens increase waste and financial burden, and delay CRC screening rates putting patients at risk. A large proportion of patients were discovered to be improperly screened as a result of this analysis, and FIT testing has been temporarily halted to ensure patient safety. Study findings have informed a national effort to improve FIT testing procedures at the VA Health System. Subsequent intervention is currently underway, which includes development of a standardized operating procedure for laboratory technicians, increased training, and streamlined patient instructions. Further analysis is in process to evaluate rejection rates following this intervention.



Disclosures:


Elizabeth A. Rowland, MD, MBA¹, Wesley A.. Robertson, MD, MPH, MPA¹, Mohamed Abdelhabib, MD¹, Jolyn Moeller, RN, ACNS-BC², Melinda Somoza, MD², Freya Spielberg, MD, MPH², Anthony Millett, MST², Alvin G. Wong, MD². P4059 - Something Doesn't FIT: Reducing Lab-Rejected FIT Specimens at the Veteran Affairs Medical Center, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.