Importance: Transitional care for elderly patients who suffer from multiple chronic medical conditions is essential to reduce the length of and improve the quality of care. According to the 2010 census, older adults accounted for 13 % of the United States population. There were 58 million Medicare enrollees with approximately $ 135 billion in expenditures for Medicare beneficiaries’ inpatient hospital costs in 2017. The average length of stay (LOS) in the acute care setting for ages 65 to 84 was 5.2 days with a mean cost of $ 11,300 per stay nationwide in 2016.

Methodology: The study was designed as a descriptive statistic through a retrospective chart review in a teaching hospital in northern New Jersey. The study sample of 102 charts randomly selected. The study sample consisted of Medicare patients 65 years and older who were diagnosed with sepsis which includes severe sepsis and septic shock ranging from the beginning of the third quarter of 2018 to the end of the second quarter in 2019.

Analysis: The variables of the study were age, gender, ethnicity, number of chronic medical conditions, mortality, diagnosis, 30-day readmission, patient’s support system in the community, transitional care, and discharged to. This study used descriptive statistics and a Kruskal-Wallis or Wilcoxon-Rank Sum test to assess the differences in LOS.

Results: There were 57 females (55.9%) and 45 males (44.1%) in the study. 50.0% of cases were 79 years and older. Sepsis were 44 cases (43.1%), severe sepsis 44 cases (43.1%), and septic shock 18 cases (17.6%). The majority of ethnicity was white with 65 cases (63%), followed by black or African-American (22.5%). 27 (24.9 %) out of 81 cases (excluded 21 deaths as an inpatient from the total 102 cases) were readmitted within 30 days after discharge. 24 (23.5 %) cases had 5 chronic medical conditions, followed by 23 (22.5%) of cases who had 4 chronic medical conditions. 99% (101 cases) had a community support system, and 3 cases (2.9 %) had transitional care APN involvement during the hospitalization. The mortality of this sample population was 20.6% (21 cases), 24.5% (25 cases) discharged to skilled nursing facilities, 17.6% (18 cases) to home with visiting nurse services, and 17.6% (18 cases) to home with family care. The mean LOS for sepsis was 9.2, severe sepsis 9.8, and septic shock 19.4. This study did not find a statistically significant factor that impacted LOS. Yet, the p-value of age was 0.149 followed by the p-value of 0.163 for comorbidity. 

Learning Objective:

• After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Purpose: This project aims to provide care coordination and transition management (CCTM) education and training to pre-licensure nursing students to strengthen preparation of students to practice in community-based ambulatory care settings.

Background: The current state of the health care system has shifted many roles for nurses from hospital settings to ambulatory care and community settings to meet patients' needs across the care continuum. These nursing roles require the development of unique knowledge, skills, and attitudes to improve CCTM in these environments. Few pre-licensure programs offer intentional education and training opportunities in ambulatory care settings. Through funding from the Health Resources and Services Administration (HRSA), a university-based school of nursing developed and implemented a comprehensive curriculum that includes didactic, clinical, and simulation components to strengthen pre-licensure nursing students' knowledge, skills, and attitudes for success in ambulatory care settings. This poster reports on learners’ perceptions of how the enhanced curriculum impacted their knowledge, skills, and attitudes toward ambulatory care in the didactic and clinical courses.

Methods: AAACN's Core Competencies for Ambulatory Care Nurses and Core Curricula in Ambulatory Care and Care Coordination and Transition Management were used as guides to develop the curriculum. Course objectives and outlines were created using an iterative approach with the grant team, comprised of educators and clinicians with expertise in CCTM, which were then reviewed by clinical partners to ensure relevancy. Similarly, topics for case studies were collaboratively identified and developed. Knowledge (competence), skills, and attitudes of learners were evaluated using the following measures: 1) a modified self-efficacy and performance in self-management support (SEPSS) survey (perceived competence) administered pre- and post-course, 2) a modified health care access tool that tracks the type of ambulatory care nursing experiences and skills during clinical (perceived skills), and 3) student reflections (attitudes). Data will be analyzed using descriptive statistics and thematic analysis. Enhancements to the accelerated BSN program were integrated into the clinical practicum experience and through didactic content in CCTM. Enhancements to the BSN program are being incorporated via an ambulatory care clinical course and a CCTM didactic course.

Results: A total of 63 students participated in the curriculum in spring/summer 2020 and another 80 students are currently engaged. Preliminary examination of pre- and post-SEPSS scores show significant differences in perceived improved ability to assess, assist, and engage in shared goal setting with patients. Learners report developing independence in skills involving care coordination, effective communication, COVID-19 assessment, and referrals. Qualitative data suggests that learners’ confidence towards CCTM improved and they felt positive about their ability to apply these skills into practice.

Conclusion/applications: This novel curriculum provides explicit education and training in ambulatory care that is often missing in pre-licensure nursing education, particularly skills in CCTM. Findings suggest that learners better understand the roles of ambulatory care nurses due to the opportunities provided in the curriculum and they are more confident about their ability to provide nursing care in ambulatory care settings. Future work will be directed toward augmenting this curriculum with additional learners and collecting a more comprehensive evaluation of their knowledge, skills, and attitudes.

Learning Objective:

• After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Background: As part of the American College of Cardiology (ACC) patient navigator program (PNP) phase II focus MI, we continued risk-specific interventions implemented in phase I to reduce AMI readmissions. Concentration was placed on identifying strategies most impactful on increasing early post-discharge follow-up as it has been promoted as a method of reducing 30-day readmission rates.2

Methods: A multidisciplinary approach was implemented to include the cardiologist, transition nurse, inpatient pharmacist, patient navigator, and the ambulatory care clinic nurse. Special needs were identified during discussions at the team’s daily multidisciplinary rounds. AMI patients received disease-specific education by the transition nurse and pharmacist prior to discharge. The patient navigator scheduled a 7-day follow-up appointment with a cardiology or outside provider based on the patient’s individualized needs prior to discharge. Follow-up phone calls were made 72 hours post-discharge by the transition nurse, and, at a minimum, 30- and 90-day calls were made by the ambulatory care clinic nurse. Each call was structured to solicit specific information regarding cardiac specific medications and symptom management and encourage follow-up appointment compliance and cardiac rehab participation.

Results: Data was collected January 2018 through September 2019. A total of 135 AMI patients were included in the National Cardiovascular Data Registry (NCDR®) Chest Pain-MI Registry™. 60% completed at least one appointment within 30 days post- discharge and 32% completed an appointment within 7 days. Follow-up calls were made within 72 hours; however, very few patients answered the call. requiring a message to be left with the nurse call-back information and appointment details. A total of 15 patients (11%) readmitted within 30 days, with 8 not having a follow-up call or completed appointment. Follow-up calls at 30-days post-discharge averaged a 77% success rate, and 90-day calls averaged 65%. A total of 16 patients (12%) readmitted within 90 days, with 8 not receiving a 30-day follow-up call. Those readmitted had one or more high risk factors including insurance limitations or unfunded status; discharge to assisted living; special caregiver requirements; active transplant evaluation; or having multiple co-morbidities, including cancer, which effected their compliance with cardiology follow-up.

Conclusions: The data reveals that in addition to inpatient interventions, telephonic nurse outreach, and early follow-up can help to reduce readmissions. Increased patient compliance with follow-up was noted in one large internal medicine practice with dedicated ambulatory care nursing staff to conduct post-hospitalization follow-up calls and ensuring a visit was completed within 7-14 days post-discharge.

References
1. Pandey A, Golwala H, Hall HM, et al. Association of US Centers for Medicare and Medicaid Services Hospital 30-Day Risk-Standardized Readmission Metric With Care Quality and Outcomes After Acute Myocardial Infarction. Findings from the National Cardiovascular Data Registry/Acute Coronary Treatment and Intervention Outcomes Network Registry–Get with the Guidelines. JAMA Cardiol. 2017;2(7):723–731. doi:10.1001/jamacardio.2017.1143
2. Tung YC, Chang GM, Chang HY, Yu TH. Relationship between Early Physician Follow-Up and 30-Day Readmission after Acute Myocardial Infarction and Heart Failure. PLoS One. 2017;12(1):e0170061. Published 2017 Jan 27. doi:10.1371/journal.pone.0170061

Learning Objective:

• After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Surgical outcomes have impact on both patient health and CMS reimbursement. Preventing poor outcomes such as surgical site infections (SSIs) and readmissions are important tasks that do not only occur in the operating room. The general OBGYN department implemented the enhanced recovery after surgery (ERAS) best practice guidelines and utilized nursing care coordinators (CCs) in the clinic to impact patient outcomes. A pre-op education program was developed by GYN Nurse CCs based on best practice and hospital guidelines to prepare patients for surgery. The education is provided by a CC via a 30-minute telehealth or in-person appointment and includes what to expect with their procedure, pre-op instructions, and post-op mobility. As part of the education, the patient is encouraged to participate in a rehabilitation program. They are also introduced to pre-op nutrition and CHG bathing which are key elements of ERAS.

Several PDCA cycles have been completed to get to current state. Current state: once the surgery is deemed necessary, the provider places the case request. The patient is automatically added to a report that the GYN CCs manage. The report is pulled daily. The GYN CC places the pre-procedure orders and ERAS pathway. Once the surgery is scheduled, the GYN CC is notified to contact the patient and schedule their pre-op, pre-op education, post-op, and COVID testing appointments.

Initially, the patient was immediately called by the CC to set up their education appointment and then later called by the surgery scheduling team. The physician’s nurse would be notified to schedule the pre-op, post-op, and COVID testing. After this process had occurred for several patients, a better process was identified. The process was updated to the current state where the CC calls the patient to schedule their appointments all at once. This simple change improved patient experience and alleviated work from the nurse team that could easily be absorbed by the CC. We found that multiple calls to the patient from different people led to fatigue, frustration, and a sense of being overwhelmed for the patient; this simple change alleviated that.
Some patients provided immediate feedback regarding their pre-operative education appointment. One patient stated, “this education was very helpful and helped me to feel prepared.” Another stated, “Usually when you decide to have surgery, you walk out of the doctor’s office feeling nervous and unsure and like you are just floating…The education [the CC] provided helped me to feel self-assured and knowledgeable.” In addition to providing education and setting up appointments, the CC has become the primary source of contact for the patient as they prepare for their surgery which allows each patient to become familiar and comfortable with a trusted member of their health care team.

Future state will include post-op follow up calls. Data is being collected regarding readmissions and surgical site infections and will be analyzed monthly. The ERAS program started in August of 2020, and to date we have provided care to over 100 patients.

Learning Objective:

• After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Problem: The ambulatory care management team at Carilion Clinic lacked the necessary tools to demonstrate readmission risk reduction for patients undergoing care transitions.

Purpose: This quality improvement project aimed to determine if implementing a real-time workflow management system which supported the prioritization, intervention tracking, and coordination of transitions of care, would result in readmission avoidance through risk reduction.

Background: The accountable care strategies team implemented an electronic transition tracking tool (T3), as one aspect of Carilion’s readmission reduction program.

Evidence from the literature: Approximately 20% of Medicare beneficiaries are readmitted within 30 days following hospital- or facility-based care (Fischer et al., 2014). Many health systems across the country have developed strategies to reduce hospital readmissions after the passage of the Patient Protection and Affordable Care Act and its requirement for the implementation of a hospital readmissions reduction program (ACA, 2010). While there are a variety of readmission risk stratification tools used to identify patients, the predictive performance of these tools, according to Kansagara et al., (2011), has been marginal due in part to the complex factors contributing to a readmission. These researchers recommend incorporating a larger data set to include social determinants of health (Kansagara et al., 2011). Patient’s social determinants have a significant impact on their readmission risk, thus ambulatory care programs which address these factors are essential (Calvillo-King et al., 2013).

EBP question: 1) Is there an impact on readmission for a patient who undergoes risk reduction strategies by a nurse using an automated patient prioritization tool with predictive interventions?

Methods: The ambulatory care management team uses a relationship-based model, partnering with patients in self-care which is grounded in Dorothea Orem’s theory of self-care (Petiprin, 2016). The aim is to support personal agency in the achievement of effective self-management. A tool was needed to replace a manual system which could identify and prioritize at risk patients and track interventions and readmissions. A real-time data system was implemented called T3; it aggregates patients from both in and out of network hospitals. T3 also ingests information from Jvion, a machine-learning platform that provides a readmission risk scoring and associated interventions. A dashboard displays patients and their risk scores, along with recommended interventions. Ambulatory care nurses working remotely select a patient for outreach, review machine-recommended interventions, and use nursing judgement for a patient-centric approach. Readmissions prevented are recorded using specific criteria.

Outcomes: On average. 2200 patients were managed each month and received risk reduction interventions. Over 11 months, 212 patients had a readmission prevented. With the average cost of a hospital stay at $11,200.00, these 212 prevented readmissions would have cost well over 2 million dollars. Most importantly, the team saved patients from sustaining additional health complications due to a readmission.

Implications for practice: Health systems focusing on readmission reduction need to consider using a predictive tool which incorporates social determinants of health and recommends targeted interventions. Prioritizing discharged patients, managing and tracking interventions, and recording readmissions prevented by ambulatory care nurses will demonstrate improved quality of care transitions.

Learning Objective:

• After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Background of the problem: Well-managed oral anticoagulant (OAC) therapy can reduce the risk of adverse events, including excessive bleeding or venous thromboembolism. The percentage of international normalized ratio (INR) values in therapeutic range for active chronic care clinic patients taking OACs, averaged 52.9% in 2018. Routine follow-up for INR checks is crucial and often challenging.

Objectives/purpose: The goal is to increase the percentage of active oral anticoagulant therapy patients in the chronic care clinic having an INR value in their recommended targeted range.

Literature review: Repeatedly missing INR value check has been associated with an increases risk for thromboembolic complications during warfarin therapy. Most patients treated with OACs spend the majority of their time with their INR values out of their recommended target range. Improving INR values within the recommended therapeutic range can reduce major adverse events. A systematic process for tracking patients should be used to minimize the possibility that a patient on warfarin therapy is lost to follow-up. Improving care coordination and the appropriate length of time between follow-up INR testing is critical to achieve the INR therapy goal.

Methods: The chronic care clinic implemented usage of an Epic tool, the INR reminder list, for all active clinic patients on OACs. Patients who are overdue for their INR check will show up in the INR reminder list. This list is reviewed daily by the LPN to make sure the patients have a follow-up appointment. The LPN reports to the RN with any patient having barriers to attending their appointment. The RN will coordinate their care based on the patients need. Coordination of care includes, but not limited to, transportation arrangements, pill box fill, and social worker consult.

Outcomes: Since initiating the project, the percentage of INR values in the targeted range improved from the average 52.9% to 56-57 % most months. Improving the process over time helped to sustain the percentage of INR values in target range. Nurses and support staff must work together to ensure that patients do not get lost in follow-up.

Conclusion: Maintaining INR values within therapeutic range is associated with better outcomes. Patients with multiple comorbidities are particularly challenging. Engaging in a patient-focused quality improvement project, with care coordination as an intervention, helps manage the OAC patient population and reduces their risk for adverse events.

Implications for nursing practice: Ambulatory care RNs provide leadership in coordination of services and collaborative efforts. The INR reminder list is a systematic process for tracking patients to minimize the lost to follow-up appointments. The INR reminder list helps to improve care coordination and the appropriate length of time between follow-up INR testing to help manage the OAC patients and reduce the risk of major adverse events while on anticoagulant therapy. Sustaining the process can be challenging; utilizing the plan/do/adjust/check cycle will assist in the progression of continual improvement.

Learning Objective:

• After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Purpose: A quality improvement (QI) project implemented on an inpatient cardiac unit evaluated the effectiveness of standardized bedside shift report (BSR) on patient-nurse communication scores as measured by CMS HCAHPS, which is part of the national public system reporting patient perceptions of hospital care1. Because communication for ambulatory care transitions begins at the patient’s bedside, the QI project encompassed this foundational setting to improve patient safety and satisfaction.

Review of literature: Improving nurse-patient communication can improve patient outcomes and satisfaction. Miscommunication between nurses and patients has contributed to ongoing patient safety issues in both the inpatient and ambulatory care settings. The Joint Commission (TJC) reported the most common cause of sentinel events is handoff communication failure2. Communication breakdown contributes to countless patient deaths. The Institute of Medicine reported between 44,000 and 98,000 patients die annually from preventable medical errors3. Nurses report difficulty with effective communication secondary to frequent interruptions, complex tasks, and inconsistencies with staffing and time limitations4. These factors can lead to omission of pertinent patient information and flawed transfers, ultimately compromising patient safety4. Effective and efficient communication is essential to provide quality patient care4. In accordance with TJC, standardized BSR is an evidence-based approach to improve inconsistencies and efficiency in patient handoff2. Evidence-based toolkits were used in the development of this project to directly engage nurses and patients in the education and implementation of standardizing patient handoff through BSR. Research shows involving patients during handoff decreases communication failures and duplication of care, thus improving patient outcomes and safety2. In addition to inpatient communication, primary care physicians are concerned with the transitions from inpatient to the ambulatory care citing omissions and delays leading to the potential of patient harm6.

Methodology: Patient handoff is an opportune time to improve nurse-patient communication, thereby contributing to positive patient outcomes. The QI project integrated the knowledge that communication directly affects patient safety and sentinel events. Using the Agency for Healthcare Research Quality bedside shift report toolkit and a five-step cyclic process, this QI project directly engaged both nurses and patients in the education and implementation processes to standardizing patient handoff through bedside shift report. The project also addressed potential barriers to bedside shift report and how to overcome these conflicts.

Analysis: Results were collected and analyzed through the CMS HCAHPS score reporting system. This system is a part of the national, standardized public reporting system that credibly and confidentially reports patient perceptions of hospital care.1 HCAHPs scores are sent to randomized patients regardless of insurance or reimbursement method.1

Results: Three months of post-data were collected and compared to pre-implementation scores (n=16). Post-data results showed an increase in nurse-patient communication scores with implementation of BSR. Results will be discussed.

Learning outcomes: Nurse leaders have a responsibility to continue identifying evidence-based strategies to optimize patient safety and quality care. Implications for practice stem from the use of toolkits to assist with development of efficient, sustainable, and quality handoff reports that establish effective communication between nurses and patients in all settings5.

Learning Objective:

• After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Purpose: Within our clinical research center, ambulatory care primary clinical research nurses (PCRN) embrace a primary nursing model of care. Our goal is to expand and improve primary nursing in high-volume ambulatory care clinics. This goal is to support nurses in developing positive relationships through continuity of patient care and consistent meaningful interactions with research participants and their families.

Description: A literature review of evidence related to primary nursing using search terms “primary nurse,” “primary nursing,” “primary nursing clinic,” and “primary nursing model” was conducted. Based on our findings, a project plan was developed to identify relevant patient populations that could potentially benefit from our model of care approach. In January 2020, we began to utilize the primary nurse category in the electronic medical record (EMR) system. Working with our IT department, we established a secure method to maintain an active list of primary patient assignments, enabling each PCRN to independently maintain consistency between the EMR system and the secure drive. The nursing progress note in the EMR facilitates communication of pertinent information on primary patients. These improvements promote best practices through education, advancing care coordination and improving transition management when caring for complex research patients. Then COVID-19 happened…

Our original strategy was to implement this plan separately, in each of our three diverse ambulatory care clinics that specialize in conditions within neuro, endocrine, craniofacial and more. The pandemic changed the project dynamics and precipitated the question of “How do we keep our connection to primary nursing, to each other, move forward and socially distance during a decrease in patient census?” We had to adapt and work together, first by establishing WebEx accounts. To adjust, each PCRN selected a patient and created a presentation to include disease, nursing diagnosis, educational needs, and primary nursing impact. Our weekly WebEx presentations led to discussion and expanding our primary nursing process.

Evaluation: Discussion summaries were compiled and organized in SharePoint to include optimizing use of visit time; building team rapport; and maintaining excellent communication regarding education, intervention, and care needs. The team was surveyed to assess the project and determine continued direction. 12 of 15 responded, of which eight wanted to continue with a focus on patient conditions. Comments included “we gained better understanding of the varied processes and practices of our nurse colleagues on other clinics” and concluded that preparation for the project provided time to reflect on “how we can best serve our primary patients.”

Outcomes and implications: This project provided a sense of new community, a connection to nursing and each other during a time of pandemic imposed isolation. Using the WebEx venue provided inclusion, especially of those working from home. Additionally, the experience has inspired topics for future development. This professional learning activity proved to be a positive growth experience for all PCRNs, improving leadership skills, promoting staff integration, and increasing awareness of our unique individual clinic environments.

Learning Objective:

• After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Background: The use of case review is a well-established teaching tool in nursing education, however there is little literature discussing case review to enhance motivational interviewing (MI) skills and professional development for nurses. Case review can provide dedicated time in a risk-free, structured environment to practice and promote skill development. This exercise can translate to real-time techniques for patient care. Historically, the department focused on MI skill development in a different format that was viewed as largely ineffective for team member development. A workgroup was convened to address these needs through a performance improvement project.

Methods: Advocate Aurora Health Care employs a group of RN care coordinators to work with a high-risk patient population with complex health needs. MI is a key component in working with these patients and developing patient-specific goals. While MI is a key component, it is also frequently identified as a continued learning need for team members. Historically, the department utilized a mixed method approach for MI skill development and difficult case review. Annual learning needs assessment results from the team concluded that this approach was not meeting the needs for a large portion of the team; 70% of team members responded neutral or negatively that the historical MI case review process enhanced critical thinking and skills. The workgroup addressed the gaps identified in the learning needs assessment and conducted a performance improvement project to develop the new case review process. Nurses identified and addressed key areas in the new process: needing time for case review, incorporating an educational focus, providing structured tool to present case, and supporting a risk-free environment to discuss cases. The workgroup created a focused approach centered around an evidence-based tool, the Wisconsin Star method, to help investigate patient factors and social determinants of health. The workgroup also developed a standardized template to present the case. Topics for case review were determined and prioritized utilizing the learning needs assessment results. The case review presentation incorporates education on the topic, a patient case for discussion, small group discussions to develop MI questions and techniques, and input from a primary care provider. Addition of an advanced practice nurse to aid in facilitating discussion and skill development has enhanced the case review. Debriefing occurs at the large group level to incorporate idea sharing. Team members leave with key phrases or techniques to use with similar patients.

Results: Post-implementation data was overwhelmingly positive, a 271% increase in team member’s perception that the revised case review process enhanced critical thinking and skills. Results of the project demonstrated that team members felt that the case review process was a safe environment to share thoughts and ideas, enhanced critical thinking skills, provided techniques to use in patient care, and kept MI in the forefront of the work. This case review model provides a framework for incorporating case review into professional nursing practice to enhance critical thinking skills and MI techniques.

Learning Objective:

• After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Transgender/gender non-binary (TGNB) individuals experience health disparities such as gaps in knowledge amongst providers and health care organizations.

To understand the level of knowledge and self-efficacy at an organizational level when providing health care related services to the TGNB population within Eastern Riverside County, an evidence-based practice (EBP) project was created using Brown and Ecoff’s EBP Institute Model. The study was a prospective cohort study that recruited a sample of 150 employees and community partners to participate in a two-hour TGNB intervention. The participants that were recruited consisted of various socio-demographic such as age, sex, sexual orientation, and gender identity backgrounds.

The data was collected using a pre-test and post-test instrument that captured information assessing the overall knowledge and level of self-efficacy of the individuals participating in the intervention. Questions consisted of: 1) how confident are you with working with the transgender/gender non-binary community, 2) how confident are you in applying your knowledge into your daily practice? Rate your knowledge in best-practices when working with the transgender community.

Data was analyzed using SPSS version 25, and responses were compared using a non-parametric Wilcox-Sign Ranks Test. Based on the findings, there is an increase in knowledge and self-efficacy after the intervention was conducted. When comparing the results on “how knowledgeable are you of the transgender community,” 28% responded very little knowledge for the pre-test while 63% responded knowledgeable/very knowledgeable on the post-test. When comparing “how confident are you working with the TGNB community,” 46% responded that they had very little confidence/somewhat confident on the pre-test, whereas 83% responded confident/very confident on the post-test. In addition, questions such as “please rate your knowledge of the transgender community, please rate your knowledge of the gender non-binary community, best practices involving the transgender community, confidence in working with the TGNB community, and confidence in applying your knowledge into your daily practice” illustrated normal distribution with (P=0.02) making the intervention significant.

As a result of the intervention and the preparation leading up to it, it was identified that the employees and community partners in attendance were receptive in more education towards culturally competent care for TGNB individuals. In addition, a shift in knowledge and self-efficacy can have a positive impact in patient care delivery at all levels of the organization. Based on the findings, the organization will implement a condensed 30-minute presentation from a subject matter expert that will cover best practices when working with the TGNB patients and/or community. Furthermore, the data that was collected will be utilized to develop and/or update future organizational health policies, program development, and additional resources needed to better improve care delivery. Overall, the findings from the intervention were beneficial and similar interventions could be applied for continuous development of trainings to address health disparities in other marginalized communities. 

Learning Objective:

• After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.