Increasing Access to Colorectal Screenings

Project Description and Rationale

The vast majority (89%) of the members of our patient community who are eligible for colorectal cancer screening are failing to undergo this essential preventive medicine evaluation. In 2021, Wyckoff’s Ambulatory Services referred 437 patients for colorectal cancer screening. Only 47 of them (11%) completed the process. There are several reasons for this failure to screen patients. Among them is the fact that at Wyckoff Heights Hospital we do not have a dedicated area for ambulatory procedures such as colonoscopies. Presently, all colonoscopies are performed inside our Operating Room in two makeshift rooms that have been adjusted to provide barely adequate space for effective, efficient management of these medical procedures on a daily basis.

 

As a result of the cramped quarters under which our gastrointestinal procedures staff works, only a limited number of colonoscopies are scheduled on a daily basis, leading to a delay in available spots for gastrointestinal procedures of several months. One of our gastroenterologists has a waiting list of 8-12 weeks for the next available colonoscopy. As patients wait months for their colonoscopies, their compliance decreases accordingly: some patients forget, some patients change their minds, and some patients, unwilling to wait, seek a colonoscopy somewhere else.

 

As a solution to decrease wait times and improve access to our patients, we are proposing a construction and renovation community project to create a 5,000 sq. ft Endoscopy Suite on the 4th floor of our hospital for the expansion of Gastroenterological procedures. This renovation will create 4 new procedure rooms with a 6-bed recovery area. By creating an area external to our operating room that is dedicated to ambulatory gastrointestinal procedures, we aim to create a space that is appropriate for both our staff and the patients, a space that is conducive to increasing our available daily procedure volume in exponential manner. This would allow us to decrease the time to colonoscopies for all patients from months to days and double our monthly volume of patients served from approximately 250 to 500, thus ensuring improved and timely patient access to this preventive procedure and increased compliance with colorectal cancer screening recommendations.

 

Estimated Start Date

October 1, 2022

Estimated End Date

September 30, 2023

 

Project Value and Importance to our Community The renovation and expansion of an ambulatory Endoscopy suite at Wyckoff Hospital is an extremely valuable project because it would allow Wyckoff to significantly increase the timely access to life-saving colorectal cancer screenings for thousands of residents in our community every year. The fact that only 11% of patients at highest risk for this cancer who are referred by Wyckoff are being screened in our community is alarming.

 

Colorectal cancer is the third most common cancer in the United States and one of the cancers highlighted for interventions in the Healthy People 2030 CDC report. One of the Healthy People 2030 goals is reducing the death rates from colorectal cancer from 13.2 per 100,000 to 8.9 per 100,000 population, and one of the strategies is to improve access to early screenings. Colorectal cancer (CRC)screening via stool testing or colonoscopy is recommended for all adults 45 years of age and older due to the increasing morbidity and mortality in patients in this age group not previously screened. If polyps are found during colorectal cancer testing, they can usually be removed before they turn into cancer. Screening can also help find cancer early, when it’s smaller and might be easier to treat. It’s important to get tested as often as recommended. For high-risk populations, i.e. a personal history of polyps, family history of colorectal cancer or other risk factors; a colonoscopy is recommended.

 

Minority communities have a substantially lower rate of compliance with colorectal cancer screening: African Americans and Hispanics with a family history of CRC have the lowest likelihood of participation in screening, with the lowest being among Hispanics (47%) compared to African American (56%) and non-Hispanic Whites (62%) according to the American Cancer Society 2010 screening data in adults >50 years old. Some of this disparity in screening rates and death rates among Hispanic and Black populations is due to poor access to medical facilities that provide colorectal cancer screenings in a timely fashion and in a location convenient to the patient. In addition, over the past two years, screening appointments have been delayed or postponed due to the COVID-19 pandemic, further delaying life-saving care and exacerbating CRC screening disparities in communities such as those served by Wyckoff Hospital. 

 

Wyckoff Hospital serve large Hispanic and Black/African American communities. Approximately 65% of Wyckoff’s patients identify as Hispanic and 20% as Black/African American. Based on Wyckoff’s population health data, 5200 patients qualified for CRC screening in 2021 and 437 were referred for CRC screening, however only 47 (11%) completed the screening. We have instituted stool testing for occult blood as a new and accepted screening tool. But high-risk patients – and those who test positive for occult blood – still need to be screened via colonoscopy, which we are not able to offer to our Brooklyn and Queens patient communities in an efficacious manner. Our goal is to reach 90% screening rates for all eligible patients utilizing a combined FIT test and colonoscopy approach.