title: 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.
  
  
  OBJECTIVE
  To evaluate practice trends in utilizing FOBT on inpatients and its impact on affecting clinical management and outcomes.
  
  
  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].
  
  
  CONCLUSIONS
  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.
authors.forename: S
authors.initials: S
authors.lastname: Mosadeghi
authors.forename: H
authors.initials: H
authors.lastname: Ren
authors.forename: J
authors.initials: J
authors.lastname: Catungal
authors.forename: I
authors.initials: I
authors.lastname: Yen
authors.forename: B
authors.initials: B
authors.lastname: Liu
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Alameda Health System-Highland Hospital, Oakland, California, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Wong
authors.forename: T
authors.initials: T
authors.lastname: Bhuket
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008297:Male; D008403:Mass Screening / Q000592:standards; D008875:Middle Aged; D009780:Occult Blood; D010043:Outcome and Process Assessment, Health Care