Published online Mar 27, 2023. doi: 10.4254/wjh.v15.i3.410
Peer-review started: November 12, 2022
First decision: January 5, 2023
Revised: January 16, 2023
Accepted: February 21, 2023
Article in press: February 21, 2023
Published online: March 27, 2023
Processing time: 131 Days and 3.9 Hours
The American Association for the Study of Liver Disease recommends that patients with cirrhosis be screened for hepatocellular carcinoma (HCC) every six months. Other researchers have shown that adherence to these guidelines is poor, but little is known about the causes of this failure.
The authors noted that many patients in their own subspecialty hepatology practice did not undergo appropriate screening. They studied factors contributing to screening failure in order to develop a possible quality improvement initiative.
The authors sought to identify root causes of HCC screening failure among patients with cirrhosis in their subspecialty heaptology clinic.
The authors identified patients with cirrhosis in their subspecialty hepatology clinic and determined whether they underwent appropriate screening. The authors reviewed the medical records of patients who did not undergo appropriate screening to identify the root causes of screening failure.
Among 1034 patients, only 489 underwent appropriate screening. The most common causes of screening failure, in descending order, were: radiology unable to schedule timely imaging, provider did not order imaging, patient canceled follow up appointment, appointments scheduled too far apart, lost to follow up, no-show to radiology appointment, and provider canceled appointment.
Even in a subspecialty hepatology clinic in which providers strive to follow guideline-based HCC screening, rates of screening were still poor. Most of the barriers to appropriate screening were due to systemic factors such as radiology availability, rather than to individual error.
HCC screening is vital to the comprehensive care of patients with cirrhosis, yet systemic and institutional barriers often prevent patients from receiving adequate care. The root causes identified in this article immediately suggest areas for possible quality improvement and provide guidance to those at other institutions.