Eliminating In-Hospital Fecal Occult Blood Testing: Our Experience with Disinvestment

A Case for Abandoning Inpatient Fecal Occult Blood Testing

“…We know FOBTs are frequently done reflexively because audit studies have shown that positive gFOBTs are frequently ignored and appropriate investigations are never pursued [4,10]. In one such audit study, gFOBTs were done reflexively at the time of digital rectal exam (DRE) with no other indication for testing being identified [5]. Routine gFOBTs should not be done at the time of DRE.…”

“…The test characteristics are accompanied by false positives and negatives, increased direct and indirect costs, delays in appropriate consultations or endoscopy, increase length of hospital stays, unnecessary procedures, and results that do not change management. Inappropriate use of FOBT can lead to both overuse and underuse of endoscopy [ 2 - 5 ].…”

“…Several studies on the utility of inpatient gFOBT have found that the initial rationale for testing are also indications for endoscopy and FOBT results should not determine the need for endoscopy [ 2 - 5 , 7 ]. Uninvestigated iron deficiency anemia (IDA) and overt GI bleeding are both appropriate indications for endoscopy and are two of the most common reasons for obtaining a gFOBT in most audit studies.…”

“…The patient went on to have continued bleeding requiring transfusions and there was a delay in endoscopy because of a false negative gFOBT. Delays in endoscopy have led to prolonged hospital stays, increased costs, as well as harm to patients [ 3 - 5 , 9 ].…”

Balancing Measures When Restricting Laboratory Testing

“…We had a similar experience with eliminating the fecal occult blood test at our institute. 2 To help guide other institutions, including ours, in pursuing similar valuebased quality improvement projects, we had a few questions.…”