S1228 Fecal Occult Blood Testing Associated With Delayed Hospital Discharge: A Quality Improvement Study

Abstract

INTRODUCTION: Fecal occult blood testing (FOBT) is a cheap test that is commonly used in outpatient and inpatient settings. The primary purpose of FOBT is to screen for colorectal cancer in an outpatient setting, as recommended by the US preventive services task force. FOBT inpatient use has not been validated. On the contrary, many reports advise against the inpatient use of FOBT. The impact of performing FOBT on hospitalization outcomes such as length of stay has (LOS) been sufficiently studied in literature. We aimed to assess whether our inpatient use of FOBT is associated with increased LOS in hospitalized patients with GI bleeding or iron deficiency anemia. METHODS: Adult inpatients from January 2016 until June 2020 with ICD-10-CM diagnoses pertaining to GI bleeding and/or iron deficiency anemia were included. The primary outcome was LOS. The secondary outcome was mortality. Variables were compared between FOBT ordered VS not ordered and FOBT positive VS negative. Standard statistical tests using Chi-square, Student t-test, Mann-Whitney U test, survival analysis, and multivariate linear regression were used. RESULTS: 4401 hospitalizations with GI bleeding and/or iron deficiency anemia were included. Mean age was 66 ± 16 years. Females represented 56.4%. GI bleeding was present in 2551 (58%) hospitalizations while iron deficiency anemia in 2256 (51.3%). FOBT was ordered in 832 (18.9%) and performed in 540 (12.3%). Ordering FOBT was associated with increased LOS (median 5.5 VS 4.4, P < 0.01) and no reduction in inpatient mortality (Table 1). Figure 1 illustrates that patients with FOBT-ordered stay longer in hospital prior to discharge. Positive FOBT occurred in 401 (74%) of performed tests. Patients with positive FOBT had higher mortality compared to negative FOBT (3.7% VS 0%, P = 0.02) (Table 2). CONCLUSION: FOBT is not indicated for inpatient settings. Although a positive FOBT result is associated with higher mortality, ordering FOBT should not delay obtaining early gastroenterology consultation and endoscopic treatment if indicated. Educational interventions should be implemented to decrease inappropriate inpatient use of FOBT testing.Table 1.: Comparison of baseline characteristics and outcomes based on FOBT order statusFigure 1.: A survival analysis plot comparing hospital discharges based on FOBT order status.Table 2.: Comparison of hospitalization outcomes based on FOBT test results