De-implementation approaches related to Fecal Occult Blood Tests (FOBT) for hospitalized patients; Implementation Science; De-implementation; Choosing Wisely;

1. Fecal Occult Blood
Tests (FOBT)
Valuable for Screening, Wasteful
for Diagnostics
Danesh, V., Gisi, B., Narayan, M., Yoder,
L., & Zad, O. (2019). Fecal occult blood
tests: valuable for screening, wasteful for
diagnostics. Clinical Nurse Specialist,
33(4), 191-194.
10.1097/nur.0000000000000460

2. Background
 Fecal occult blood tests (FOBTs) have been validated for
colorectal cancer screenings to detect early-stage colorectal
cancer or adenomas since 1967.
 The use of the FOBT as a screening test can promote early
detection of colorectal cancer and may reduce mortality in at-
risk populations.
 If patients are symptomatic with the suspicion of rectal blood
loss, melena, and/or abdominal pain then endoscopic
evaluation is recommended.
Dube 2013 Can J Gastroenterol
van Rijn 2012 Eur J Gastroentero Hepatol
Hewitson 2011 Cochrane Database Syst Rev

3. Purpose
To describe the de-implementation process of using FOBTs for hospitalized
patients.
Physician-nurse collaborations were established to assess FOBT use and to
promote FOBT information distribution using both formal and informal channels.
Danesh 2019 Clin Nurs Spec

4. Approach
Data-based poster displays to communicate ‘valuable for screening and
wasteful for diagnostics’.
Visualizations of test use and patient cost throughout all facilities.
Formal presentations to pair FOBT-related clinical practice guidelines with local
utilization data of FOBT orders for hospitalized adults
Word of mouth to deliver one-on-one discussions with physicians, advanced
practice providers and nurses.
Discussion integration into interdisciplinary rounds and charge nurse check-ins.
Discussion upon order entry review with specialist providers.
Danesh 2019 Clin Nurs Spec

5. Data-based poster displays
Clinical Practice Guidelines Local Utilization Data
Danesh 2019 Clin Nurs Spec
FOBT order charges used as a proxy for cast savings, in the
absence of calculating varied reimbursement rates from
different payers:

6. Opportunities for practice change
 Formal and informal approaches to pair Clinical Practice Guidelines with local
utilization data
 Incorporate changes to the electronic health record to automate the
cancellation of tests ordered for hospitalized patient
 Optimal topic for clinician-led quality improvement initiatives
 Aligns with the premise of the Choosing Wisely campaign to evaluate
everyday practices
 Danesh, V., Gisi, B., Narayan, M., Yoder, L.,
& Zad, O. (2019). Fecal occult blood tests:
valuable for screening, wasteful for
diagnostics. Clinical Nurse Specialist, 33(4),
191-194. 10.1097/nur.0000000000000460

7. References
 Danesh, V., Gisi, B., Narayan, M., Yoder, L., & Zad, O. (2019). Fecal occult blood tests:
Valuable for screening, wasteful for diagnostics. Clinical Nurse Specialist, 33(4), 191-
194. 10.1097/NUR.0000000000000460
 Dube, C. (2013). Putting an end to the misuse of the fecal occult blood test in
diagnostic medicine. Can J Gastroenterol, 27(12), 695-695.
 van Rijn, AF, Stroobants, AK, Deutekom, M, et al. (2012). Inappropriate use of the
faecal occult blood test in a university hospital in The Netherlands. Eur J of
Gastroenterol Hepat, 24 (11), 1266-1269.
 Hewitson, P. (2011). Screening for colorectal cancer using the faecal occult blood test,
Hemoccult. Cochrane Database Syst Rev, 2.
@DaneshVC