Utilization of fecal occult blood test in the acute hospital setting and its impact on clinical management and outcomes

Abstract

Background:Despite lack of evidence supporting the use of fecal occult blood test (FOBT) in the acute hospital setting, FOBT is commonly used in the inpatient setting for reasons other than colorectal cancer (CRC) screening.Aims:To evaluate practice trends in utilizing FOBT on inpatients and its impact on affecting clinical management and outcomes.Materials and Methods:A cross-sectional study of consecutive adult patients undergoing FOBT from January 1, 2011 to December 31, 2011 during an acute medical admission at a large urban safety net hospital was performed. Indications for FOBT, and the impact of FOBT results on endoscopic procedures performed and clinical outcomes were assessed. The number of inpatient endoscopic procedures before and after discontinuing inpatient FOBT was also assessed.Results:A total of 207 inpatient FOBTs were performed in 2011. The most common reason cited for FOBT was anemia (36%, n = 74) followed by gastrointestinal (GI) bleeding (27%, n = 55). Interestingly, 23% (n = 47) of the patients undergoing inpatient FOBT had overt GI bleeding. As expected, patients with positive FOBT were significantly more likely to undergo endoscopic examinations (P < 0.01). After discontinuing the availability of inpatient FOBT, patients were less likely to undergo endoscopic examinations [odds ratio (OR) 0.80, 95% confidence interval (CI) 0.75-0.85].Conclusion:Inappropriate utilization of FOBT in the inpatient setting is common, even when the indication does not support its use. Setting limitations on inpatient FOBT may reduce the inappropriate utilization of inpatient FOBT. Quality improvement initiatives are needed to educate clinicians on the appropriate use of FOBT, which is primarily for average risk CRC screening.

Use and abuse of fecal occult blood tests: a community hospital experience

“…A total of 3 colon cancer were found in the inappropriate group, although it is important to consider none of the FOBT testing was performed for this reason specifically. The study done by Mosadeghi et al [19] showed that the odds of getting further investigations are much higher when the results of the FOBT done for any reason is positive. Taking this finding and using it with our results, it is highly probable that if inappropriate FOBTs were not done for our patients, we would have had a smaller number of positive FOBT results leading to a fewer amounts of performed colonoscopies potentially leading to lower hospitalization cost and length of stay.…”

Not FIT for Use: Fecal Immunochemical Testing in the Inpatient and Emergency Settings

“…FIT was not intended as a replacement, but as it remained an orderable test for colorectal cancer screening, it appeared to have taken the place of gFOBT by some clinicians. Previous studies had sounded the alarm on the inappropriate use of FOBT in the acute hospital setting; [7][8][9][10][11][12][13][14][15][16][17] our study adds to this body of literature as the first study to exclusively evaluate FIT in this context. Our primary finding was that similar to gFOBT, the inappropriate use of FIT in the inpatient and emergency settings was widespread: of the 550 tests done, 99.5% of tests were done for indications other than colorectal cancer screening.…”

“…[7][8][9][10][11][12][13][14][15][16][17] Studies of FOBT (FIT or gFOBT) use for indications other than colorectal cancer screening have consistently shown that the tests are nearly always used inappropriately-often in the presence of confounding factors (such as certain medications for gFOBT) or contraindications, such as advanced age. [7][8][9][10][11][12][13][14][15][16][17] Such inappropriate use has led to high rates of both false-positive and false-negative results, with consequences such as delays in appropriate care (eg, colonoscopy for potential colorectal cancer or bleeding sources in the case of false-negative results) or unnecessary procedures and consultations from false-positive results and has little impact on clinical decision-making for hospitalized patients. [7][8][9][10][12][13][14][15][16][17] In this setting, it leads to added cost and has potential for inaccurate results without providing clinical value.…”

“…[7][8][9][10][11][12][13][14][15][16][17] Such inappropriate use has led to high rates of both false-positive and false-negative results, with consequences such as delays in appropriate care (eg, colonoscopy for potential colorectal cancer or bleeding sources in the case of false-negative results) or unnecessary procedures and consultations from false-positive results and has little impact on clinical decision-making for hospitalized patients. [7][8][9][10][12][13][14][15][16][17] In this setting, it leads to added cost and has potential for inaccurate results without providing clinical value.…”

A Case for Abandoning Inpatient Fecal Occult Blood Testing

“…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.…”