S1128 Mind Over Bowel: A QA/QI Assessment of IBS Referral Practices at the East Orange Veterans Affairs Medical Center

Introduction: Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal (GI) disorder marked by abdominal pain and altered bowel habits, without structural or biochemical abnormalities. The American College of Gastroenterology (ACG) recommends a positive diagnostic approach that involves limiting routine testing in the absence of alarm features, screening for similar conditions like Celiac disease or inflammatory bowel disease (IBD), and referring to GI only after appropriate evaluation. From 2023–2025, the East Orange VAMC GI clinic saw increased referrals for presumed IBS without appropriate workup, with many patients ultimately diagnosed with other conditions. This study aims to assess residents’ knowledge of IBS screening and referral guidelines to identify gaps contributing to these trends. Methods: A IBS screening/referral knowledge questionnaire was developed using ACG clinical guidelines and Rome IV diagnostic criteria for IBS. Sixteen questions were designed, with 10 assessing knowledge of workup and management, 4 questions assessing confidence and 2 assessing attitudes regarding the role of primary care physicians (PCPs) in IBS as well as the overall approach to diagnosing IBS. Residents’ responses were then evaluated by whether they had answered knowledge questions correctly or incorrectly, in addition to their confidence level, and the results were then stratified by level of training. Questions with <80% correct response rates were deemed knowledge gaps areas requiring targeted education. Results: From a total of 112 eligible residents, 75 responses were recorded (66.9% response rate). Topics with correct response rates <80% included: duration of symptoms required for diagnosis of IBS (53.3% total correct), role of fecal calprotectin testing (29.3% total correct), role of Celiac disease testing (50.7% total correct), role of colonoscopy (70.6% total correct). Confidence in diagnosis and management ranged from 28% to 45.3% across training levels. On the role of PCPs, 43.3% agreed they should refer to GI after identifying signs of IBS, 40.8% disagreed, and 15.8% were neutral. Additionally, 90.8% believed IBS is a diagnosis of exclusion. Conclusion: These findings highlight key knowledge gaps among residents across all 3 levels of training regarding IBS diagnosis and management, including misperceptions about diagnostic modalities and the role of PCPs as well as the recommended positive diagnostic approach to treating IBS. Low confidence and high rates of incorrect responses suggest a need for targeted education to improve referral practices.