Journal for healthcare quality : official publication of the National Association for Healthcare Quality
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Fecal occult blood testing (FOBT) is recommended by national guidelines for colorectal cancer (CRC) screening and has been shown to reduce both the incidence and mortality of CRC. FOBT screening is a complex process and little is known concerning the best methods for implementing FOBT screening in primary care clinics. The purpose of this study was to determine if direct gastroenterology (GI) service notification of all positive FOBT results in improved time for provider response and colonoscopy. ⋯ Data were collected prospectively following implementation of a direct referral strategy and compared with two retrospective time periods during which the ordering practitioners were responsible for follow-up of all positive FOBT. Implementation of immediate GI referral of positive tests eliminated improper and neglected follow-up, and resulted in shorter delays in provider response time and colonoscopy completion. Inappropriate use of FOBT was observed in 49% of patients, indicating that further interventions in primary care clinics to improve the quality of FOBT screening are necessary.
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Surgeons have been slow to incorporate industrial reliability techniques. Process control methods were applied to surgeon waiting time between cases, and to length of stay (LOS) after colon surgery. Waiting times between surgeries were evaluated by auditing the operating room records of a single hospital over a 1-month period. ⋯ These process issues are both expensive and adversely affect the quality of service offered by the institution. Process control mechanisms were suggested or implemented to improve these surgical processes. Industrial reliability and quality management tools can easily and effectively identify process control problems that occur on surgical services.