The Effect of Removal of Point-of-Care Fecal Occult Blood Testing on Performance of Digital Rectal Examinations in the Emergency Department
Received 22 October 2009; received in revised form 10 December 2009; accepted 16 December 2009. published online 11 January 2010. Corrected Proof
Study objective
We determine whether removing point-of-care fecal occult blood testing from the emergency department (ED) is associated with a decrease in documented digital rectal examinations.
Methods
We performed a retrospective observational chart review study examining documented digital rectal examinations, before and after removal of a point-of-care fecal occult blood test, on all adult patients who presented to our ED with chief complaints that were likely to warrant a fecal occult blood test (intervention-sensitive). We studied the 6 months immediately before and after switching from bedside fecal occult blood testing to immunohistochemical laboratory fecal occult blood testing. We compared the results with those from a similar cohort of patients who presented during the same period, with chief complaints that would warrant a digital rectal examination for reasons other than fecal occult blood test (intervention-insensitive).
Results
A total of 4,981 and 5,557 patients met our inclusion criteria during the before and after intervention periods, respectively. We observed an overall reduction of 10% (95% confidence interval [CI] 8% to 12%) in digital rectal examinations in patients with intervention-sensitive chief complaints. The largest relative decreases in digital rectal examinations were observed in patients with chief complaints of abdominal pain, nausea/vomiting, and diarrhea. Smaller decreases were observed in gastrointestinal bleeding, constipation, and rectal problem. There was an overall reduction of 3% (95% CI 0% to 5%) in documented digital rectal examinations in intervention-insensitive chief complaints. After controlling for all covariates, digital rectal examinations decreased in the postintervention period for intervention-sensitive (odds ratio 0.44 [95% CI 0.39 to 0.50]) and, to a lesser extent, for intervention-insensitive (odds ratio 0.67 [95% CI 0.52 to 0.86]) conditions.
Conclusion
Removal of point-of-care fecal occult blood test from our ED was associated with a reduction in digital rectal examinations, particularly among chief complaints that may require fecal occult blood testing.
⁎Denver Health Medical Center, Residency in Emergency Medicine, Denver, CO
†the Department of Emergency Medicine, University of Colorado Denver School of Medicine, and Colorado Emergency Medicine Research Center, Aurora, CO
Address for correspondence: Adit A. Ginde, MD, MPH, 12401 E 17th Ave, Campus Box B-215, Aurora, CO 80045; 720-848-6777, fax 720-848-7374
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
Supervising editor: Steven M. Green, MD
Author contributions: NJC and AAG conceived the study, designed the trial, and obtained institutional review board approval. NJC and MY performed electronic chart abstraction and data collection. AAG provided statistical advice and the primary data analysis. NJC authored the article, and all authors contributed substantially to its revision. NJC takes responsibility for the paper as a whole.
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