Improving Fecal Immunochemical Test Collection for Colorectal Cancer Screening During the COVID-19 Pandemic.

Area of Science:

• Colorectal Cancer Screening
• Public Health
• Quality Improvement in Healthcare

Background:

• Colonoscopy is a primary colorectal cancer (CRC) screening method, complemented by noninvasive tests like fecal occult blood tests (FOBT) and fecal immunochemical tests (FIT).
• The COVID-19 pandemic negatively impacted CRC screening rates, necessitating adaptations in screening protocols.
• The James A. Haley Veterans Affairs Hospital (JAHVAH) faced challenges with high rates of incorrectly collected FIT samples, prompting a quality improvement (QI) project.

Purpose of the Study:

• To identify root causes of incorrectly collected FIT samples.
• To implement a quality improvement project to increase the rate of correctly collected and testable FIT kits.
• To improve the efficiency of CRC screening using FIT during and after the COVID-19 pandemic.

Main Methods:

• A multidisciplinary team conducted an ambulatory QI project using Plan-Do-Study-Act (PDSA) cycles to address FIT collection inefficiencies.
• Root cause analysis identified six major issues contributing to incorrect FIT submissions.
• Interventions included redundant patient reminders, centralized FIT dispersal, and improved patient-FIT interface usability.

Main Results:

• The project focused on addressing missing collection dates, the most frequent reason for FIT kit rejection.
• The rate of FIT kits with missing collection dates decreased from 24% to 14% after PDSA implementation.
• The overall rate of correctly returned FIT kits increased from 38% to 72%, exceeding the 20% improvement goal.

Conclusions:

• Fecal immunochemical test (FIT) is a valuable tool for colorectal cancer (CRC) screening, especially when in-person visits are restricted.
• The increased demand for FITs during the COVID-19 pandemic highlighted existing process deficiencies.
• The JAHVAH QI project successfully improved FIT collection workflow and demonstrated the effectiveness of PDSA cycles in enhancing screening processes.