FOB - moving away from POC

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Hi all,

For those of you who have discontinued POC fecal occult blood testing, how did you address the needs of your respective clinical areas?

We are on the verge of removing this test from ED settings, and I am working with clinicians and our main lab to envision an alternate scenario.

Thanks for any help you can provide.

10 Replies

James Beck

Wed Dec 03, 2025 at 2:43PM

I don't have any suggestions for you, but I am surprised you are able to get your clinical areas to go along with this idea? Yes, of course there are better, more specific and sensitive tests now, but for the purposes that the old FOB kits are used for (gross loss of blood), it is hard to beat with regard to ease of use. As long as it is used with that understanding, it still has its place, IMO. Are your clinical areas going along with the idea of an alternate scenario?

Jeremy MacDonald

Wed Dec 03, 2025 at 2:51PM

When we proposed a transition away from point-of-care (POC) fecal occult blood testing (FOBT) to a laboratory-performed immunological test, several issues with the traditional guaiac-based method were reviewed:

The traditional FOBT process lacked adequate control. Test cards and developer bottles were stored inconsistently—often found in drawers or pockets—with some materials past their expiration date. Additionally, there was no reliable oversight of who was performing the testing. We had no real control over who was doing the testing in comparison to who had done the competency for it.
We were purchasing more than twice the number of kits relative to the number of tests actually resulted.
The guaiac method is neither highly sensitive nor specific. Manufacturer instructions require patients to avoid certain foods (e.g., meat) prior to testing and recommend collecting specimens from three separate bowel movements before a negative result can be considered reliable.

We moved to the iFOB immunological assay, we gain several advantages:

The test is specific to human hemoglobin, eliminating dietary restrictions.
It provides greater analytical sensitivity and specificity.
It resolved the regulatory and compliance issues we were having by centralizing the process under laboratory oversight.
It reduces waste and unnecessary purchasing, as kit use will be controlled and monitored within the laboratory.

James Beck

Wed Dec 03, 2025 at 3:08PM

Definitely agree with all those justifications, I am simply saying I am surprised you are not met with a response of "we know all that but we don't care - we need a quick test and do not want to wait for lab to process and result - we accept its limitations." But kudos to you for putting quality and utilization first! :)

Jeremy MacDonald

Wed Dec 03, 2025 at 3:23PM

Oh, we definitely got the response you cited, we stressed it was only a matter of time before we got regulatorily citied and lost the ability to perform the test at all, this in conjunction with the cost savings and assurances that the test would be done in a timely manner swayed upper leadership. After implementation we still got "grumblings" and requests to change back but they couldn't really defend the request as we were meeting the turn-around for it. We did these 6 or 7 years ago now, it's been years since I've heard any complaints regarding this move.

Karissa Goulder

Wed Dec 03, 2025 at 3:23PM

In my last place of employment there was very little POC outside of the lab. It was a single, stand-alone hospital with associated clinics. In the ER, there were 17 beds. They were stocked with Hemocue cards and would perform the collection or submit a fresh stool sample and send to lab. Lab was then responsible for QC, storage of developer, etc. There wasn't any kickback not being able to perform it in ED and then it was in a more controlled environment for testing. How big is the facility you are dealing with?

Brian Castle

Thu Dec 04, 2025 at 9:21AM

@Jeremy MacDonald ->absolutely. We are locked in that exact scenario. I've worked with this group for 6 years, and they still can't seem to adequately work with me to have a central supply and control over products. Every month there are anywhere from 1-3 operators doing this test that have not completed their assigned training. The test is not being used in a manner that is consistent with manufacturer instructions. None of the patients are vetted for dietary or medication restrictions. I recently presented a slide deck with all the current literature and our program status, and it was a bit sobering for some of the ED heads. But now we get to envision what life looks like after this if we remove it. From your response, the iFOB definitely sounds appealing as an alternative. I would like something under lab control with the ED sending specimen.

@Karissa Goulder -> this program has about 250 operators testing every year. They want all their docs, their PAs, and in recent years they have wanted rotating residents. Even if I were to keep this testing, a reform/revamp of program would be in order, and probably come with the condition of dropping some operators.

Danielle Cooper

Thu Dec 04, 2025 at 9:33AM

@Brian Castle - would you mind sharing your slide deck? I too am receiving push back from my ED physicians with eliminating the FOB. Like Jeremy MacDonald, we offer the iFOB in Lab but they are convinced it is imperative to retain testing capabilities at patient bedside.

Jeremy MacDonald

Thu Dec 04, 2025 at 9:49AM

@ Brain Castle,

Provided your Laboratory is licensed under JC or CAP....

I would also remind them that ultimately this testing falls under the scope of practice of the lab and more specifically the Laboratory Medical Director, it's their licensure that allows them to perform the test. It's also the Medical Directors licensure that is at risk if the test system is found to be regulatory non-complaint. The Laboratory MD ultimately has the final "say" in what tests are performed and how.

Tim Tarrant

Thu Dec 04, 2025 at 1:54PM

@Jeremy MacDonald, what is the instrument platform are you performing iFOB on?

@ Brian Castle, would you mind sharing your slide deck with me as well?

Thank you,
Tim

Jeremy MacDonald

Thu Dec 04, 2025 at 2:14PM

@ Tim: Sekisui OSOM IFOB

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FOB - moving away from POC