S609 Primary Pathology Results From an Ambulatory Safety Net for Colon Cancer Surveillance

Introduction: Ambulatory Safety Nets (ASNs) are systems that integrate into the Electronic Medical Record (EMR) and identify patients or lab results for further follow up. ASNs have been implemented across several integrated health systems and have been effective in improving the care of patients with cancer. In this study, we examined the effectiveness of an ASN in engaging patients who were overdue for colonoscopy and identifying cases of colon cancer and high grade dysplasia. Methods: In this study, an ASN was piloted in 2022, and fully implemented in 2024 at 2 academic medical centers and 2 community hospitals in an integrated healthcare system. Patients who were 90 or more days overdue for a colonoscopy with a return interval of 6 months, 1 year, and 2 years in the EMR were identified and reviewed by patient navigators. Navigators then reached out to patients’ primary care providers to order a colonoscopy. Patients received scheduling instructions from patient navigators and the endoscopy department. Once patients completed their colonoscopy, their primary pathology was reviewed and documented. Cases with adenocarcinoma, high grade dysplasia, and other clinically urgent features were referred to the medical director for review to ensure timely access to appropriate care. Results: A total of 2,150 colonoscopies were initiated by the ASN between January 2024 and April 2025, 9 patients had 2 colonoscopies. Pathology reports identified 6 adenocarcinoma, 1 follicular lymphoma, 33 dysplasia (11 high grade, 22 low grade, 6 unspecified), 208 sessile serrated adenomas, 15 serrated adenomas, 42 tubulovillous adenomas, 706 tubular adenomas, 207 with colitis, 160 hyperplastic polyps, 23 inflammatory polyps, 1 juvenile polyp, 57 other, 226 without abnormality, and 459 without specimens. Conclusion: Our findings from this study demonstrate the effectiveness and value of an ASN in identifying patients who are overdue for colonoscopy screening. Additionally, this study highlights the importance of updating accurate return intervals in the EMR when improving outcomes and ensuring access to timely care. This study also identified opportunities for improvement in the prevention of colon cancer and led to the creation of standardized colonoscopy preparation instructions across multiple languages as well as a smart letter integrated into the EMR to share results with patients. Reference Emani S, Sequist TD, Lacson R, Khorasani R, Jajoo K, Holtz L, Desai S. Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer. Jt Comm J Qual Patient Saf. 2019 Aug;45(8):552-557.