Table 1

Change ideas tested by IMC

DriversChange ideas
Organisational alignment
  • ECMC leadership pledged ‘80% by 2018 CRC screening’ initiative by NCCRT.10

  • Schedule regular meetings with key members to share successes, discuss opportunities for improvement and request allocation of resources to overcome barriers.

  • Implement FIT by ECMC Director of Laboratory Services.

  • Offer FIT as an option to colonoscopy in average risk patients.

  • Increase access for colonoscopy.

Team building
  • Train nursing staff to dispense FITs and provide patient education on CRC screening options and FIT instructions.

  • Appoint patient navigator to track FIT orders, FIT completion and urgent colonoscopy referrals.

  • Nursing staff to identify eligible patients for CRC screening during previsit planning.

  • Engage information technology staff to confirm accuracy of EHR database.

  • Prepare monthly run charts to inform team including administrative leadership.

  • Place stamper on discharge sheet to remind nursing staff about FIT order by physician.

  • Develop workflow whereby GI coordinator notifies physicians of colonoscopy no-shows.

  • Improve process to optimise adherence to scheduled colonoscopy appointment.

  • Develop curriculum to enhance motivational interview techniques among physicians and staff and implement interactive workshops.

Patient engagement
  • Physicians review current processes for CRC screening with patients and offer new option of FIT or colonoscopy for average risk patients.

  • Outline patient-related barriers to colonoscopy and FIT and develop plans to overcome.

  • Provide education to patients about CRC screening.

  • Engage patients in designing simplified instructions for FIT.

  • Assign social worker to improve patient related barriers of transportation for colonoscopy.

  • Patient navigator assesses barriers for FIT completion by calling patients.

  • Discuss CRC screening at every visit or at least annually for patients who refused in the past.

  • Offer precolonoscopy appointment by GI staff to discuss procedure and bowel preparation to improve understanding and adherence.

  • Create workflow to ensure that a physician reviews abnormal FIT results and discuss with patient in a timely manner.

  • Offer incentive to patients for FIT completion.

Leverage health information technology
  • Design new EHR patient database to identify and track patients for CRC screening.

  • Design new nursing workflow for CRC screening to improve physicians’ efficiency during clinic visit.

  • Design new FIT workflow in EHR to document discussion with patients about FIT and colonoscopy options.

  • Call and send letters to those patients who are lost to follow-up for population health.

  • Track completed FIT and colonoscopy and ensure physicians’ acknowledgement and follow-up.

  • Generate registry to track patients who refused CRC screening and allocate resources to overcome barriers.

  • Send automated letter to notify patient about negative FIT result.

  • Enter colonoscopy results as a structured data field in EHR to improve accuracy of database.

  • Enter refusal for FIT or colonoscopy as a structured data in EHR.

  • Enter EHR reminder for high risk patients due or overdue for colonoscopy.

Identification of eligible patients
  • Physician and nurse documents family history of CRC and tracks pathology report of polyps from previous colonoscopy in EHR.

  • Medical office assistant retrieves and scans previous colonoscopy report and enters it as a structured data and also scans pathology report in EHR.

Close loops for referrals and tests
  • Ensure clear indication for FIT or colonoscopy.

  • Patient navigator tracks FIT orders for completion.

  • Schedule urgent colonoscopy and track completion in FIT-positive patients.

  • Track follow-up clinic appointments and improve adherence.

  • Track no shows for colonoscopy and notification to PCP.

  • Develop tracking system for positive FIT and abnormal colonoscopy report.

  • Establish a protocol to notify patients in a timely manner about positive FIT; schedule urgent colonoscopy and follow-up in clinic.

  • Improve communication with patients when unable to reach by phone; send a letter to remind of scheduled appointment to review positive FIT report.

  • CRC, colorectal cancer; ECMC, Erie County Medical Center; FIT, faecal immunochemical test; IMC, internal medicine clinic; NCCRT, National Colorectal Cancer Roundtable; PCP, primary care provider