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Reducing Rejected Fecal Immunochemical Tests Received in the Laboratory for Colorectal Cancer Screening

Cheng, Caleb; Ganz, David A.; Chang, Evelyn T.; Huynh, Alexis; De Peralta, Shelly

The Journal for Healthcare Quality (JHQ): March/April 2019 - Volume 41 - Issue 2 - p 75–82
doi: 10.1097/JHQ.0000000000000181
Original Article
Continuing Education

Background: Colorectal cancer (CRC) screening decreases CRC incidence; however, many patients are not successfully screened.

Purpose: To improve screening rates at our institution by decreasing the rate of rejected fecal immunochemical tests (FITs), a means of CRC screening, from 28.6% to <10% by December 2017.

Methods: Specimens were rejected for the following reasons: expired specimen, lack of recorded collection date/time, lack of physician orders, incomplete patient information, and illegible handwriting. Multidisciplinary teams devised the following interventions: FIT envelope reminder stickers, automated FIT patient reminder phone calls, a laboratory standard operating procedure, an accessioning process at satellite laboratories, revisions to a clinical reminder when offering FIT, and provision of FIT-compatible printers to clinics.

Results: Total specimens received each month ranged from 647 to 970. Fecal immunochemical test rejection rates fell from 28.6% in June 2017 to 6.9% in December 2017 with a statistically significant decrease (p-value = .015) between the intervention period (May 2017–October 2017) and the postintervention period (November 2017–May 2018).

Conclusions: Targeted interventions with stakeholder involvement are essential in reducing the rejection rate.

Implications: The decreased rejection rate saves resources by decreasing the need to rescreen patients whose specimens were rejected, and may improve CRC screening rates.

For more information on this article, contact Caleb Cheng at

Dr. C. Cheng's effort was supported through the Quality Scholars Program funded by the VA Office of Academic Affiliations (#TQS 65-000).

The authors declare no conflicts of interest.

© 2019 National Association for Healthcare Quality
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