直肠出血是结直肠癌最常见的症状，指南建议及时随访，通常采用结肠镜检查，以确保及时诊断结直肠癌。确定直肠出血患者的闭环闭合率和易损过程点。回顾性队列研究，使用2018年1月1日至2020年12月31日期间，对2个主要诊所（城市学术诊所和附属社区卫生中心）年龄≥40岁且诊断为直肠出血的患者进行病历审查。患者被分类为已完成推荐的随访进行后处理（“闭环”）与非处理（“开环”）。开环患者病例被分为六种类型的过程失败。共有 837 名患者在研究窗口内诊断出直肠出血。 67 例因既往结肠切除术、临床表现与上消化道出血更一致、图表审查中无直肠出血记录或在随访期间过期而被排除，只剩下 770 例患者。主要结局是分类为以下类别的患者病例的百分比“开环”并将这些病例分为六类已确定的过程失败。22.3% 的患者 (N = 172) 未能及时接受建议的直肠出血检查。最大的失败类别是未安排手术的患者 (N = 62, 36%)，其次是已安排手术但从未安排手术的患者 (N = 44, 26%) 或安排但随后取消或未保留的患者 (N = 31, 18%）。虽然开环在 COVID-19 大流行爆发后有所增加，但这种差异在我们的研究期间并不显着。大量因直肠出血而前往初级保健的患者未能接受建议的检查。大多数人要么没有订购手术，要么订购了手术但从未安排或取消且未保留，这表明这些是未来干预措施中要针对的重要失败模式。确保可靠的订购和流程以及时安排和完成手术是改善初级保健直肠出血患者诊断流程的关键领域。© 2023。作者获得普通内科医学会的独家许可。

Rectal bleeding is the most common presenting symptom of colorectal cancer, and guidelines recommend timely follow-up, usually with colonoscopy to ensure timely diagnoses of colorectal cancer.Identify loop closure rates and vulnerable process points for patients with rectal bleeding.Retrospective cohort study, using medical record review of patients aged ≥ 40 with index diagnosis of rectal bleeding at 2 primary practices-an urban academic practice and affiliated community health center, between January 1, 2018, and December 31, 2020. Patients were classified as having completed recommended follow-up workup ("closed loop") vs. not ("open loop"). Open loop patient cases were categorized into six types of process failures.A total of 837 patients had coded diagnoses of rectal bleeding within study window. Sixty-seven were excluded based on prior colectomy, clinical presentation more consistent with upper GI bleed, no rectal bleeding documented on chart review, or expired during the follow-up period, leaving 770 patients included.Primary outcomes were percentages of patient cases classified as "open loops" and distribution of these cases into six categories of process failure that were identified.22.3% of patients (N = 172) failed to undergo timely recommended workup for rectal bleeding. Largest failure categories were patients for whom no procedure was ordered (N = 62, 36%), followed by patients with procedures ordered but never scheduled (N = 44, 26%) or scheduled but subsequently cancelled or not kept (N = 31, 18%). While open loops increased after the onset of the COVID-19 pandemic, this difference was not significant within our study period.Significant numbers of patients presenting to primary care with rectal bleeding fail to undergo recommended workup. The majority either have no procedure ordered, or procedure ordered but never scheduled or cancelled and not kept, suggesting these are important failure modes to target in future interventions. Ensuring reliable ordering and processes for timely scheduling and completion of procedures represent critical areas for improving the diagnostic process for patients with rectal bleeding in primary care.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.