Oklahoma Chapter of the American College of Physicians Virtual Meeting 2020

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Browsing Oklahoma Chapter of the American College of Physicians Virtual Meeting 2020 by Author "Cerqueira, Oliver"

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    Improving Outpatient Follow-Up After Hospitalization
    (2020-10) McGinn, Addison; Hurst, Caleb; Blasdel, Jacob; Bordelon, Brian; Abdelmonem, Ahmed; Sharwani, Fahad; Lesselroth, Blake; Cerqueira, Oliver; Corbett, Audrey
    Introduction: Hospital readmission is costly, in both patient quality of life and healthcare expenditures. Timely post-discharge follow-up has shown to reduce preventable readmissions. Efforts should be aimed at improving coordination of follow-ups. The aim of this quality improvement project was to increase post-hospital discharge follow-up by 20% for academic primary care patients admitted to a local tertiary care hospital by June 2020. This QI project was conducted at St. John Medical Center and the OU Internal Medicine Clinic utilizing Plan-Do-Study-Act methodology (PDSA). Patients admitted to OU inpatient teams who also designated OU Internal Medicine as their PCP were included in the study. An EMR query was utilized to measure follow-ups completed within 14 days of discharge. A process map was made, showing intervention points. Gap Analysis/Scatter Diagram was used to show points of largest impact. Methods: PDSA #1: Senior residents were given access to AllScripts (the clinic EMR scheduling program) to directly schedule patient follow-up appointments within 14 days of discharge. Follow-up appointments were included in patients’ discharge paperwork.    PDSA #2: Prior to discharge, patients were screened by care managers for a follow-up home visit. If appropriate, a multidisciplinary team of providers conducted an onsite follow-up visit within 14 days of discharge. Results: After PDSA #1: Residents surveyed after the first PDSA cycle admitted feeling overwhelmed with additional tasks and inconsistently scheduled appointments in AllScripts. In addition, EMR review demonstrated a high no-show rate for patients with follow-up appointments. Due to these results, we sought alternative options. After PDSA #2: Three patients were visited in their homes for an onsite 14-day follow-up appointment. Unfortunately, this process was put on hold given the COVID outbreak. At baseline, 31.6% of patients discharged from the hospital attended post-discharge follow-up visit within 14 days. This percentage declined to 29.2% after our interventions. Conclusion: The low rate of hospital discharge appointments within two weeks of discharge indicates that many patients are lacking crucial follow-up care. This project found that having residents enter appointments directly into AllScripts and performing home visits within 14 days of discharge made no difference in the overall rate of successful post-discharge follow-up visits. Weaknesses of this study include but are not limited to the gap of data between July 2019 and March 2020 and the small number of home visits that were performed. This project confirms the concern that unless new approaches to significant post-discharge follow-up barriers are considered, increasing the percentage of successful follow-up appointments will remain a difficult task.
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    PDSA Cycles Increase Screening for Smoking Cessation
    (2020-10) Abdelmonem, Ahmed; Baab, Kelsey; Cerqueira, Oliver; Corbett, Audrey
    Introduction: Smoking represents the leading cause of preventable disease, disability and death in the United States, disproportionately affecting lower-income populations1. Smoking cessation has been shown to reduce the associated health risks and to lead to a decrease in early mortality. Due to the significant impact of smoking on our patient population, the students at OU’s student-run, free clinic, Bedlam Clinic, decided to implement a series of Plan-Do-Study-Act (PDSA) cycles to address this issue. PDSA cycles are widely used for quality improvement in healthcare systems and have been shown to improve outcomes2. Our aim was to improve tobacco screening and counseling in OU Bedlam student-run clinic by 20% by June 2020. Methods: From September 2019-May 2020, teams of third-year medical students, PA students, nursing students, social work students, and faculty attendings implemented PDSA rapid improvement cycles. The goal was to increase smoking screening and cessation education above the current baseline of 49.4% by the end of the year. Each individual team created a plan, which they implemented in the clinic. The number of screenings, counseling sessions, and smoking cessations were recorded per team. The teams met bi-monthly to discuss and improve upon the plan. By the third PDSA cycle, the entire clinic agreed to implement the protocol of the team with the largest increase in tobacco screenings. The protocol chosen involved an interdisciplinary approach: the nursing student initiated the screen, the Medical/PA student provided counseling for those interested, and the social work student provided resources for those motivated to quit smoking. Results: At the first PDSA cycle, 49.4% of eligible patients at Bedlam Clinic had a tobacco screening completed, with an upper and lower confidence level of 53.6% and 45.1%. Monthly data points following the initial PDSA cycle were consistently above average. By July, 2020, after 4 PDSA cycles, the average tobacco screening rose from 49.4% to 59.8%. Conclusion: Implementing a multidisciplinary, quality improvement project to increase smoking cessation screening at the OU Bedlam student-run clinic was successful. Tobacco screening at the Bedlam Clinic improved by 20.1% from its baseline. The PDSA cycles elucidated that documentation of the tobacco screening process was being recorded incorrectly in the EMR. Once this was established, we implemented a protocol ensuring that this important step was not forgotten. Specifically, nursing students documented the screening in the EMR at the beginning of the visit. This step was implemented across the entire clinic by February 2020, significantly improving tobacco screenings. This project demonstrates that a student-led, annual, QI project using simple rapid cycle improvement leads to improved patient care. These projects should continue to be implemented at the Bedlam Clinic and further expanded to the remaining OU clinics.