Updated: 04/22/25
Updated: 04/22/25
Learning outcome: Describe how a pediatric clinic used Lean methodology to increase the numbers of eligible patients receiving lead screening, driving quality improvement and improved patient care using evidence-based practices.
Background: In October of 2022, a pediatric ambulatory care clinic within a large academic medical center in the Midwest identified the need to improve compliance with routine lead screening for pediatric patients before turning 12 months old. In the state of Kansas, children under the age of six continue to be at risk for lead poisoning because large numbers of buildings in the state were built before changes to lead paint regulations were implemented in 1978. Early testing and intervention can help mitigate long-term health risks caused by exposure to lead, such as brain development issues and damage to kidney and nervous systems. In October 2022, only 58% of eligible patients had completed lead screening. Barriers to performing lead screening were identified, including the time and burden of an additional lab visit and resistance to having a blood sample drawn by venipuncture. The clinic was tasked with improving the percentage of pediatric patients receiving lead screenings by their 12-month visit.
Methods: Lean standard work processes were implemented. To ensure patients were screened for lead by their 12-month appointment, nurse-driven pre-visit planning was completed, identifying those patients scheduled in clinic one week in advance. The focus age for screening is initially 12 months of age at the patient’s well check. If we were unable to complete at the 12-month visit, we would try to capture at the next visit, at 15 months, with the overall goal of completion prior to the patient’s second birthday. To help remove the lab barrier, the clinic partnered with an external vendor to provide a lead screening kit that used a fingerstick rather than a lab draw. The test could be performed in the clinic at the time of their scheduled visit. Nurses and medical assistants were trained in performing the new lead screening process. The technique required a precise amount of blood placed on a specific place on a specimen filter paper.
Results: By implementing pre-visit planning and in-clinic testing using a fingerstick, this urban clinic with 35 nurses and 16 medical assistants has been able to screen 87% of our patients within the focused age range, a 29% increase over a two-year period.
Conclusion: With these practice changes, this pediatric clinic has been able to screen for lead the children that may otherwise have missed testing, mitigating the risks caused by lead poisoning. Using a systematic process to adjust workflows and added pre-visit planning can play a key role in improving overall screening percentages in children.
Background: In October of 2022, a pediatric ambulatory care clinic within a large academic medical center in the Midwest identified the need to improve compliance with routine lead screening for pediatric patients before turning 12 months old. In the state of Kansas, children under the age of six continue to be at risk for lead poisoning because large numbers of buildings in the state were built before changes to lead paint regulations were implemented in 1978. Early testing and intervention can help mitigate long-term health risks caused by exposure to lead, such as brain development issues and damage to kidney and nervous systems. In October 2022, only 58% of eligible patients had completed lead screening. Barriers to performing lead screening were identified, including the time and burden of an additional lab visit and resistance to having a blood sample drawn by venipuncture. The clinic was tasked with improving the percentage of pediatric patients receiving lead screenings by their 12-month visit.
Methods: Lean standard work processes were implemented. To ensure patients were screened for lead by their 12-month appointment, nurse-driven pre-visit planning was completed, identifying those patients scheduled in clinic one week in advance. The focus age for screening is initially 12 months of age at the patient’s well check. If we were unable to complete at the 12-month visit, we would try to capture at the next visit, at 15 months, with the overall goal of completion prior to the patient’s second birthday. To help remove the lab barrier, the clinic partnered with an external vendor to provide a lead screening kit that used a fingerstick rather than a lab draw. The test could be performed in the clinic at the time of their scheduled visit. Nurses and medical assistants were trained in performing the new lead screening process. The technique required a precise amount of blood placed on a specific place on a specimen filter paper.
Results: By implementing pre-visit planning and in-clinic testing using a fingerstick, this urban clinic with 35 nurses and 16 medical assistants has been able to screen 87% of our patients within the focused age range, a 29% increase over a two-year period.
Conclusion: With these practice changes, this pediatric clinic has been able to screen for lead the children that may otherwise have missed testing, mitigating the risks caused by lead poisoning. Using a systematic process to adjust workflows and added pre-visit planning can play a key role in improving overall screening percentages in children.
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.
Updated: 04/22/25
Updated: 04/22/25
Learning objective: Evaluate whether the inclusion of intentional rounding by nursing staff affects the satisfaction of patients attending a clinic appointment.
Description: Intentional rounding (IR) is purposeful therapeutic communication between nurses and patients during regular checks with patients using standardized protocols. Evidence suggests that IR may reduce the incidence of patient falls and medication errors, and may improve pain management, earlier detection of patient deterioration, and patient satisfaction. Further, IR is associated with better communication between staff and patients. We were unable to find a study or QI project of IR that involved nurses of ambulatory care patients.
Our health care system has an ambulatory care rooming protocol that states nursing staff members should intentionally round on patients every 15 minutes. However, this policy is inconsistently implemented across ambulatory care clinics. Patients in some clinics were not being updated properly as they waited during their appointments. Other patients were told they could leave appointments before the provider was done with the visit, causing confusion, miscommunication, potential errors, and patient dissatisfaction during appointments.
Evaluation/outcome: Our intervention used AIDET (acknowledge, introduce, duration, explanation, thank you) as a rounding communication strategy to keep patients informed during clinic appointments. Clinic nursing staff kept track of patients every 15 minutes in one of two options to time their IR: 1) whiteboards placed outside patients' doors on which rounding time was tracked or 2) timers in EPIC to monitor rounding times.
The nursing staff of three clinics participated in this project. The Press-Ganey Medical Practice Survey item “degree to which you were informed about any delays” was the project outcome measure. This item was measured on a 5-point Likert scale and provided as part of a de-identified monthly report to clinic managers. Data was collected in November 2023 (pre-intervention) and monthly from February to May 2024 (post-intervention) and analyzed by frequencies.
Conclusions: This project has assisted the nursing staff in improving patient satisfaction and communication with patients as they move through their clinic visits. We plan to continue and expand intentional patient rounding within our clinics.
Description: Intentional rounding (IR) is purposeful therapeutic communication between nurses and patients during regular checks with patients using standardized protocols. Evidence suggests that IR may reduce the incidence of patient falls and medication errors, and may improve pain management, earlier detection of patient deterioration, and patient satisfaction. Further, IR is associated with better communication between staff and patients. We were unable to find a study or QI project of IR that involved nurses of ambulatory care patients.
Our health care system has an ambulatory care rooming protocol that states nursing staff members should intentionally round on patients every 15 minutes. However, this policy is inconsistently implemented across ambulatory care clinics. Patients in some clinics were not being updated properly as they waited during their appointments. Other patients were told they could leave appointments before the provider was done with the visit, causing confusion, miscommunication, potential errors, and patient dissatisfaction during appointments.
Evaluation/outcome: Our intervention used AIDET (acknowledge, introduce, duration, explanation, thank you) as a rounding communication strategy to keep patients informed during clinic appointments. Clinic nursing staff kept track of patients every 15 minutes in one of two options to time their IR: 1) whiteboards placed outside patients' doors on which rounding time was tracked or 2) timers in EPIC to monitor rounding times.
The nursing staff of three clinics participated in this project. The Press-Ganey Medical Practice Survey item “degree to which you were informed about any delays” was the project outcome measure. This item was measured on a 5-point Likert scale and provided as part of a de-identified monthly report to clinic managers. Data was collected in November 2023 (pre-intervention) and monthly from February to May 2024 (post-intervention) and analyzed by frequencies.
Conclusions: This project has assisted the nursing staff in improving patient satisfaction and communication with patients as they move through their clinic visits. We plan to continue and expand intentional patient rounding within our clinics.
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.
Updated: 04/22/25
Updated: 04/22/25
Project description: Licensed practical nurses (LPNs) play a vital role in the Veterans Healthcare Administration (VHA) community, particularly within ambulatory care services. However, the specialized knowledge and skills required for effective management of care in outpatient settings are often not included in traditional nursing curricula. To address this gap, the LPN Academy was developed to build upon existing nursing knowledge and expand it to include critical content components relevant to ambulatory care settings.
The LPN Academy is structured to align with professional standards established by the National Association of Licensed Practical Nurses and the American Academy of Ambulatory Care Nursing (AAACN) standards 8 through 15. This program also integrates the VHA’s mission, core values, and strategic plan, ensuring that LPNs are equipped to deliver high-quality, standardized care to patient populations, especially focusing on gerontological conditions commonly encountered in ambulatory care.
The Academy employs a blended learning approach that combines didactic teaching with scenario-based discussions, interactive activities, and hands-on practice. This methodology aims to enhance the clinical knowledge and skills of LPNs, ultimately improving patient outcomes and ensuring consistent, quality care.
Learning outcome: Upon completion of this activity, participants will be able to effectively manage the care of gerontological populations in ambulatory care settings, utilizing evidence-based practices and adhering to professional standards.
Program implementation: The program was piloted with a comprehensive needs assessment, revealing significant interest among LPNs in gerontology certification and training in medication and vaccine administration. The Academy's curriculum was developed to address these needs, offering a two-day course that includes lectures, simulations, role-playing, case studies, and small group discussions.
Evaluation: Post-program evaluations demonstrated a 25% increase in knowledge, with 77% of participants scoring 80% or above on assessments. Participants reported high satisfaction with the course content, teaching methods, and the applicability of new skills and knowledge to their practice.
Conclusion: The LPN Academy effectively enhances the knowledge and skills of LPNs in ambulatory care settings, aligning with professional standards and addressing critical gaps in traditional nursing education. By focusing on gerontological care and evidence-based practices, the program ensures that LPNs are well-prepared to meet the needs of their patient populations and contribute to the overall quality of care in the VA community.
The LPN Academy is structured to align with professional standards established by the National Association of Licensed Practical Nurses and the American Academy of Ambulatory Care Nursing (AAACN) standards 8 through 15. This program also integrates the VHA’s mission, core values, and strategic plan, ensuring that LPNs are equipped to deliver high-quality, standardized care to patient populations, especially focusing on gerontological conditions commonly encountered in ambulatory care.
The Academy employs a blended learning approach that combines didactic teaching with scenario-based discussions, interactive activities, and hands-on practice. This methodology aims to enhance the clinical knowledge and skills of LPNs, ultimately improving patient outcomes and ensuring consistent, quality care.
Learning outcome: Upon completion of this activity, participants will be able to effectively manage the care of gerontological populations in ambulatory care settings, utilizing evidence-based practices and adhering to professional standards.
Program implementation: The program was piloted with a comprehensive needs assessment, revealing significant interest among LPNs in gerontology certification and training in medication and vaccine administration. The Academy's curriculum was developed to address these needs, offering a two-day course that includes lectures, simulations, role-playing, case studies, and small group discussions.
Evaluation: Post-program evaluations demonstrated a 25% increase in knowledge, with 77% of participants scoring 80% or above on assessments. Participants reported high satisfaction with the course content, teaching methods, and the applicability of new skills and knowledge to their practice.
Conclusion: The LPN Academy effectively enhances the knowledge and skills of LPNs in ambulatory care settings, aligning with professional standards and addressing critical gaps in traditional nursing education. By focusing on gerontological care and evidence-based practices, the program ensures that LPNs are well-prepared to meet the needs of their patient populations and contribute to the overall quality of care in the VA community.
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.
Updated: 04/22/25
Updated: 04/22/25
Background: Wait times for patients, especially those undergoing oncology treatment, can increase their stress and anxiety and have been associated with decreased satisfaction scores. Based on a nursing needs assessment, the ambulatory treatment center (ATC) nurses at the League City Houston area location (HAL) frequently had difficulty finding their patient assignment on the center’s electronic health record (EHR) patient list. This caused staff dissatisfaction and delays with starting patient treatment which resulted in low patient experience scores for 'extent appointments began on time.
Objective of project: The aim of this project was to increase patient top box scores for “extent appointments began on time” and increase staff satisfaction in ease of finding assigned patients in the ambulatory treatment center at the League City Houston area location.
Process of implementation: A nursing needs assessment was completed on the League City HAL ATC nurses via a Qualtrics survey that asked ease of finding assigned patients on the patient list, delays in patient care due to assignment process, assignment errors due to assignment process, transparency of charge nurse scheduling practices, fairness of assignment load, and frequency of 2+ C1D1 assignment in a day or C1D1+ transfusions in a day.
To address concerns from the needs assessment, an action plan was created to adopt the ATC TMC process whereby nurses are “assigned” a patient, placing them directly on an individualized nurse’s list in the electronic health record. The action plan also included sharing this process with other HALs for their adoption to create standardization across the institution.
Evaluation of successful practice: In November of 2023, the League City HAL ATC top box score for “extent appointments began on time” was 48.4. Intervention start date: December 2023, intervention end date: January 2024. Post-data: Date 1: February 2024, value: 64.1; date 2: March 2024, value: 64; date 3: April 2024, value: 63.6. Results of staff satisfaction data: “Ease of finding assigned patients on the patient list” increased 26% post intervention. Perception of “delays in patient care due to assignment process” decreased by 23%. Perception of “transparency of charge nurse scheduling practices” increased by 30%.
Relevance in clinical practice: Multiple studies have demonstrated a strong correlation between prolonged wait times and patient dissatisfaction. By conducting a needs assessment and determining where nurses were being impacted by inefficiencies in their patient assignment process, an action plan was developed that enabled them to see patients sooner and provide a timelier start to their treatment. Avoiding delays led to a superior patient experience as reflected in the improvement of top box scores for “extent appointments began on time” and staff satisfaction post-implementation.
Objective of project: The aim of this project was to increase patient top box scores for “extent appointments began on time” and increase staff satisfaction in ease of finding assigned patients in the ambulatory treatment center at the League City Houston area location.
Process of implementation: A nursing needs assessment was completed on the League City HAL ATC nurses via a Qualtrics survey that asked ease of finding assigned patients on the patient list, delays in patient care due to assignment process, assignment errors due to assignment process, transparency of charge nurse scheduling practices, fairness of assignment load, and frequency of 2+ C1D1 assignment in a day or C1D1+ transfusions in a day.
To address concerns from the needs assessment, an action plan was created to adopt the ATC TMC process whereby nurses are “assigned” a patient, placing them directly on an individualized nurse’s list in the electronic health record. The action plan also included sharing this process with other HALs for their adoption to create standardization across the institution.
Evaluation of successful practice: In November of 2023, the League City HAL ATC top box score for “extent appointments began on time” was 48.4. Intervention start date: December 2023, intervention end date: January 2024. Post-data: Date 1: February 2024, value: 64.1; date 2: March 2024, value: 64; date 3: April 2024, value: 63.6. Results of staff satisfaction data: “Ease of finding assigned patients on the patient list” increased 26% post intervention. Perception of “delays in patient care due to assignment process” decreased by 23%. Perception of “transparency of charge nurse scheduling practices” increased by 30%.
Relevance in clinical practice: Multiple studies have demonstrated a strong correlation between prolonged wait times and patient dissatisfaction. By conducting a needs assessment and determining where nurses were being impacted by inefficiencies in their patient assignment process, an action plan was developed that enabled them to see patients sooner and provide a timelier start to their treatment. Avoiding delays led to a superior patient experience as reflected in the improvement of top box scores for “extent appointments began on time” and staff satisfaction post-implementation.
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.
Quyen Hurlburt, MSN, RN, CCTC, Director of Nursing and Clinical Operations, Cedars-Sinai Medical Network | Kelly Ong, BSN, PHN
Updated: 04/22/25
Updated: 04/22/25
Problem/background: The Centers for Disease Control and Prevention guideline for disinfection and sterilization in healthcare facilities outlines the requirements for monitoring of sterilizers to ensure effective and safe reprocessing practices. Reprocessing compliance is determined by the submission of documents related to monitoring autoclave maintenance, as well as biological, chemical, and mechanical indicators. Patient safety depends on properly reprocessed and well-maintained instruments in accordance with manufacturer’s instructions; therefore, best practices should be applied. In April 2021, the reprocessing compliance rate was ~65%. This was due to an inefficient process that included ~5-10 forms that were completed manually and submitted in person. In 2022, an electronic process was implemented to improve efficiency. However, it did not allow for multiple forms to be submitted simultaneously, which led to the implementation of a new platform, REDCap. This platform not only enables the submission of multiple data entries at once but also supports data export. Lengthy data analysis and limited viewing access remained a challenge for monitoring compliance. In March 2024, a Tableau dashboard was established to pull data directly from REDCap for easy analysis and reporting.
Smart aim: To increase the reprocessing compliance rate to >95% as evidenced by monthly compliance reports by end of FY24.
Methods/implementation: In April 2021, infection prevention nurse collected baseline data that revealed an average reprocessing compliance rate ~65%. Issues that contributed to low compliance included missing or late submissions and repeated or incorrect dates of submission. Beginning April 2022 to April 2024, in collaboration with enterprise information system (EIS) and operations teams, new processes and platforms were implemented for improvement. Established REDcap platform in March 2022 allowing for multiple data submissions and ability to export data to Excel. Collaborated with EIS team to design a Tableau dashboard in January 2024 specific for reprocessing. Implemented Tableau dashboard in April 2024: directly pulled data from REDcap, filter option to view data for specific clinics and forms, and accessibility for operations team to monitor compliance. Increased site visits and conducted trainings to ensure understanding of reprocessing compliance and document submission processes. Incorporated reprocessing compliance education and document submission process into new and annual employee competency training. Targeted education to clinics identified as non-compliant with missing data for reinforcement.
Results: In April 2021, the average monthly compliance was 65%. One year later, it slightly improved to 70%. In April 2023 and 2024, it further increased to 92% and 95% respectively.
Discussion/conclusion/implications: Goal was met, as evidenced by average monthly compliance rates increasing by 30% over 3 years. Improvement was noted in number of reports submitted, accuracy in data, and timely submissions. Implementation of electronic platforms improved efficiency in the process for monitoring compliance. Recordkeeping of reprocessing documentation is an important practice for maintaining process integrity and contributes to quality and patient safety. This project can be implemented in any ambulatory care clinic setting performing instrument reprocessing.
Smart aim: To increase the reprocessing compliance rate to >95% as evidenced by monthly compliance reports by end of FY24.
Methods/implementation: In April 2021, infection prevention nurse collected baseline data that revealed an average reprocessing compliance rate ~65%. Issues that contributed to low compliance included missing or late submissions and repeated or incorrect dates of submission. Beginning April 2022 to April 2024, in collaboration with enterprise information system (EIS) and operations teams, new processes and platforms were implemented for improvement. Established REDcap platform in March 2022 allowing for multiple data submissions and ability to export data to Excel. Collaborated with EIS team to design a Tableau dashboard in January 2024 specific for reprocessing. Implemented Tableau dashboard in April 2024: directly pulled data from REDcap, filter option to view data for specific clinics and forms, and accessibility for operations team to monitor compliance. Increased site visits and conducted trainings to ensure understanding of reprocessing compliance and document submission processes. Incorporated reprocessing compliance education and document submission process into new and annual employee competency training. Targeted education to clinics identified as non-compliant with missing data for reinforcement.
Results: In April 2021, the average monthly compliance was 65%. One year later, it slightly improved to 70%. In April 2023 and 2024, it further increased to 92% and 95% respectively.
Discussion/conclusion/implications: Goal was met, as evidenced by average monthly compliance rates increasing by 30% over 3 years. Improvement was noted in number of reports submitted, accuracy in data, and timely submissions. Implementation of electronic platforms improved efficiency in the process for monitoring compliance. Recordkeeping of reprocessing documentation is an important practice for maintaining process integrity and contributes to quality and patient safety. This project can be implemented in any ambulatory care clinic setting performing instrument reprocessing.
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.
Kamillia Dela Paz, MSN, RN-BC, Laboratory Support Services RN Supervisor, Cedars-Sinai Medical Network | Quyen Hurlburt, MSN, RN, CCTC, Director of Nursing and Clinical Operations, Cedars-Sinai Medical Network
Updated: 04/22/25
Updated: 04/22/25
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.
Gloria Okorley, MSN, RN, AMB-BC, Ambulatory Care Nurse Manager, University of Kentucky Healthcare | Brenda Patel-Hughes, BSN, RN | Stephanie Peeples, BSN, RN
Updated: 04/22/25
Updated: 04/22/25
Learning objective: Evaluate how education and a pre-implementation survey to identify screening barriers may affect universal depression screening outcomes in three pediatric sub-specialty clinics.
Background: Half of all mental health issues develop by age 14 years. Depression affects about 1 in 4 children. Guidelines from the United States Preventative Services Task Force2 and the American Academy of Pediatrics recommend annual universal depression screening of adolescent patients ages 12 years and older for major depressive disorder with a formal self-report screening tool either on paper or electronically. Both screening for depression and referral to mental health providers continue to be issues in pediatric populations.
Purpose: Evaluate the effect of an educational intervention and a pre-implementation survey focused on screening barriers on universal depression screening outcomes in pediatric sub-specialty clinics.
Methods: Universal depression screening was implemented at least annually for children aged 12 to 17 years using the PHQ-A with a screening score of >10 (moderate depressive symptoms or greater) in our adolescent medicine (AM), cardiology (PC), and medical specialty (PMS) clinics between July 2023 and May 2024. One month before implementation, registered nursing staff in all clinics were educated about the depression screening process, outcomes, and follow-up process specific to each clinic. Before education, nurses in the PC clinic were sent an electronic survey to identify barriers and concerns about depression screening implementation. Education in the PC clinic also addressed concerns noted in the pre-education survey.
Screening process: Every age-appropriate child is screened as follows: 1) PC clinic: every visit, occurring every 6 months-3 years; 2) AM and PMS clinics: annual screening; 3) patients with a screening score of >10 are seen in all clinics by a social worker. The PC and PMS clinics give paper surveys to adolescents to complete, while the AM clinic uses an iPad for survey completion.
Outcomes: Outcomes are reported as a percentage of adolescents screened at baseline (in the month before screening education) and at 2-month intervals thereafter.
Evaluation/conclusions: All clinics experienced improvements in adolescent depression screening. The AM and PMS clinics had lower screening percentages of adolescents compared to the PC clinic. It is also possible that addressing concerns of the PC staff about depression screening and integrating this information into the PC education had a significant positive result on PC screening outcomes.
Background: Half of all mental health issues develop by age 14 years. Depression affects about 1 in 4 children. Guidelines from the United States Preventative Services Task Force2 and the American Academy of Pediatrics recommend annual universal depression screening of adolescent patients ages 12 years and older for major depressive disorder with a formal self-report screening tool either on paper or electronically. Both screening for depression and referral to mental health providers continue to be issues in pediatric populations.
Purpose: Evaluate the effect of an educational intervention and a pre-implementation survey focused on screening barriers on universal depression screening outcomes in pediatric sub-specialty clinics.
Methods: Universal depression screening was implemented at least annually for children aged 12 to 17 years using the PHQ-A with a screening score of >10 (moderate depressive symptoms or greater) in our adolescent medicine (AM), cardiology (PC), and medical specialty (PMS) clinics between July 2023 and May 2024. One month before implementation, registered nursing staff in all clinics were educated about the depression screening process, outcomes, and follow-up process specific to each clinic. Before education, nurses in the PC clinic were sent an electronic survey to identify barriers and concerns about depression screening implementation. Education in the PC clinic also addressed concerns noted in the pre-education survey.
Screening process: Every age-appropriate child is screened as follows: 1) PC clinic: every visit, occurring every 6 months-3 years; 2) AM and PMS clinics: annual screening; 3) patients with a screening score of >10 are seen in all clinics by a social worker. The PC and PMS clinics give paper surveys to adolescents to complete, while the AM clinic uses an iPad for survey completion.
Outcomes: Outcomes are reported as a percentage of adolescents screened at baseline (in the month before screening education) and at 2-month intervals thereafter.
Evaluation/conclusions: All clinics experienced improvements in adolescent depression screening. The AM and PMS clinics had lower screening percentages of adolescents compared to the PC clinic. It is also possible that addressing concerns of the PC staff about depression screening and integrating this information into the PC education had a significant positive result on PC screening outcomes.
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.
Updated: 04/22/25
Updated: 04/22/25
Erie County Medical Center (ECMC) in Buffalo, NY, serves as the largest safety net hospital in the region, caring for a high-risk population disproportionately affected by healthcare disparities tied to socioeconomic status and racial/ethnic backgrounds. These disparities contribute to poor outcomes in chronic conditions like diabetes. Erie County has higher diabetes-related hospitalization and mortality rates than the rest of New York State, underscoring the urgency of effective diabetes control.
The primary objective of this project (optimizing diabetes management in primary care) was to develop and implement a comprehensive diabetes management protocol to enhance patient outcomes and streamline care delivery. This initiative sought to address transportation challenges, improve patient awareness, and promote adherence and self-management behaviors. By tailoring interventions—including lifestyle modifications, medication counseling, education, outreach, and care coordination—to each patient’s unique needs, the project actively addressed social determinants of health (SDOH), such as health literacy and transportation barriers, within a team-based care model.
Between 2021 and 2024, ECMC’s targeted intervention program, developed and led by an RN, significantly improved diabetes management outcomes. The proportion of patients achieving glycemic control rose from 49.9% to 66.8%, reflecting a 33.87% improvement. The average A1C among primary care patients decreased to 7.3. Evidence-based strategies, including personalized education, regular monitoring, and team-based care delivery drove these improvements.
This project demonstrates the transformative potential of addressing SDOH and disparities through structured evidence-based protocols. It highlights the critical role of innovative nursing practices in improving diabetes outcomes and advancing health equity in underserved populations.
Learning outcome: By the end of this poster session, attendees will be able to identify evidence-based strategies for improving diabetes management in underserved populations, recognize the impact of addressing social determinants of health on patient outcomes, and apply a team-based care model to enhance adherence and self-management behaviors in their own practice.
The primary objective of this project (optimizing diabetes management in primary care) was to develop and implement a comprehensive diabetes management protocol to enhance patient outcomes and streamline care delivery. This initiative sought to address transportation challenges, improve patient awareness, and promote adherence and self-management behaviors. By tailoring interventions—including lifestyle modifications, medication counseling, education, outreach, and care coordination—to each patient’s unique needs, the project actively addressed social determinants of health (SDOH), such as health literacy and transportation barriers, within a team-based care model.
Between 2021 and 2024, ECMC’s targeted intervention program, developed and led by an RN, significantly improved diabetes management outcomes. The proportion of patients achieving glycemic control rose from 49.9% to 66.8%, reflecting a 33.87% improvement. The average A1C among primary care patients decreased to 7.3. Evidence-based strategies, including personalized education, regular monitoring, and team-based care delivery drove these improvements.
This project demonstrates the transformative potential of addressing SDOH and disparities through structured evidence-based protocols. It highlights the critical role of innovative nursing practices in improving diabetes outcomes and advancing health equity in underserved populations.
Learning outcome: By the end of this poster session, attendees will be able to identify evidence-based strategies for improving diabetes management in underserved populations, recognize the impact of addressing social determinants of health on patient outcomes, and apply a team-based care model to enhance adherence and self-management behaviors in their own practice.
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.
Updated: 04/22/25
Updated: 04/22/25
As the ambulatory care setting plays an increasingly vital role in health care, clinics are experiencing a rise in both patient volumes and acuity. For a large academic medical center with 100+ clinics spread across a large metroplex, the ambulatory care setting is essential in managing chronic disease complexities. Effective ambulatory care rapid response teams are essential to ensuring safe, high-quality care in urgent and emergent situations.
Challenges with prior orientation methods included variable engagement, staff bandwidth, and inconsistent quality of training. Addressing these issues required developing a standardized, comprehensive, and flexible orientation process utilizing the institution's learning management system. The RRT program manager and nursing professional development practitioner created an innovative online learning module including documentation procedures, policies, member expectations, standing medical orders, event reporting instructions, emergency medications, and ongoing training. Upon module completion, a designated RRT site coordinator meets with the new member to validate competencies and coordinates a mentorship with an experienced member. This blended learning approach enhances professional skills and learner satisfaction, while supporting balanced content development. This approach of combining online and in-person instruction also enhances professional skills and learner satisfaction, while supporting balanced content development. This has resulted in decreased leadership and educator burden with onboarding, while team members are able to complete the online module at their own pace. This flexibility also minimizes disruptions to their clinic duties and patient care.
Scaling a proper orientation model across multiple clinic sites has many challenges and risks falling short of its goals. A redesign of the orientation process for RRT members aims to address gaps in emergency preparedness and staff comfort to improve team effectiveness and efficiency. In 13 years, the ambulatory care RRT has grown from four buildings and 80 members to 17 buildings and a roster of over 400. The variance in patient populations, staffing models, and building designs present challenges in maintaining consistency in RRT structure and response across all locations.
A post-orientation survey showed that 98% of those onboarded felt the new method provided sufficient education on emergency response concepts, with 93% feeling confident in their ability to respond as an RRT member. Of the 298 respondents, 97% felt satisfied with the new onboarding process. Additionally, RRT members who had been onboarded before the new process were asked to complete the new onboarding process as a means of comparison. Of those surveyed, 91% felt the new onboarding process offered better preparation, with 90% preferring the module onboarding format to previous methods.
This new orientation module and pathway will continually be modified over time to best meet the evolving needs of the ambulatory rapid response teams. Ultimately, our goal is to improve staff competency, thus reducing time for emergency interventions and minimizing costly burdens on extra resources. A robust and effective onboarding fosters a more engaged and prepared team, enhancing patient care and safety in ambulatory care settings.
Challenges with prior orientation methods included variable engagement, staff bandwidth, and inconsistent quality of training. Addressing these issues required developing a standardized, comprehensive, and flexible orientation process utilizing the institution's learning management system. The RRT program manager and nursing professional development practitioner created an innovative online learning module including documentation procedures, policies, member expectations, standing medical orders, event reporting instructions, emergency medications, and ongoing training. Upon module completion, a designated RRT site coordinator meets with the new member to validate competencies and coordinates a mentorship with an experienced member. This blended learning approach enhances professional skills and learner satisfaction, while supporting balanced content development. This approach of combining online and in-person instruction also enhances professional skills and learner satisfaction, while supporting balanced content development. This has resulted in decreased leadership and educator burden with onboarding, while team members are able to complete the online module at their own pace. This flexibility also minimizes disruptions to their clinic duties and patient care.
Scaling a proper orientation model across multiple clinic sites has many challenges and risks falling short of its goals. A redesign of the orientation process for RRT members aims to address gaps in emergency preparedness and staff comfort to improve team effectiveness and efficiency. In 13 years, the ambulatory care RRT has grown from four buildings and 80 members to 17 buildings and a roster of over 400. The variance in patient populations, staffing models, and building designs present challenges in maintaining consistency in RRT structure and response across all locations.
A post-orientation survey showed that 98% of those onboarded felt the new method provided sufficient education on emergency response concepts, with 93% feeling confident in their ability to respond as an RRT member. Of the 298 respondents, 97% felt satisfied with the new onboarding process. Additionally, RRT members who had been onboarded before the new process were asked to complete the new onboarding process as a means of comparison. Of those surveyed, 91% felt the new onboarding process offered better preparation, with 90% preferring the module onboarding format to previous methods.
This new orientation module and pathway will continually be modified over time to best meet the evolving needs of the ambulatory rapid response teams. Ultimately, our goal is to improve staff competency, thus reducing time for emergency interventions and minimizing costly burdens on extra resources. A robust and effective onboarding fosters a more engaged and prepared team, enhancing patient care and safety in ambulatory care settings.
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.
Victoria Zhu, DNP, RN, Regional Operations Director for Complex Care , The Everett Clinic
Updated: 04/22/25
Updated: 04/22/25
Seeking the right level of care at the right time can be complicated for older adult patients with multiple chronic conditions. Outpatient health care has evolved, utilizing numerous modes to monitor and deliver care. Call Us First (CUF) is a care management team of telephonic triage nurses created to ensure affordability, equity, and quality access for older adults in our evolving healthcare system.
Background: CUF was formed in 2020, and one year after its inception had grown from serving 13 to 20 primary and urgent care clinics in Washington state.
Purpose: The purpose of this DNP project is to evaluate the Call Us First telephonic triage quality improvement initiative that was started in 2020 at Optum Care Washington.
Methods: The program performance office evaluation from the Center for Disease Control was utilized for step-by-step approach to evaluate the CUF program. The population using the program was characterized by demographic data. The recommendations by CUF were explored. Hospital utilization metrics were reviewed.
Results: Between September 2023 to November 2023, there were n=1738 callers. There was a statistically significant (p=.01) difference, whereby most patients (87.4%) contacting CUF were seen within the recommended time of care. Review of the 30-day period after triage call showed overall 95.7% of cases did not result in hospital utilization.
Conclusion: CUF has potential to be scaled to help improve care delivery for primary care practices by guiding patients for better access to the right level of care at the right time.
Background: CUF was formed in 2020, and one year after its inception had grown from serving 13 to 20 primary and urgent care clinics in Washington state.
Purpose: The purpose of this DNP project is to evaluate the Call Us First telephonic triage quality improvement initiative that was started in 2020 at Optum Care Washington.
Methods: The program performance office evaluation from the Center for Disease Control was utilized for step-by-step approach to evaluate the CUF program. The population using the program was characterized by demographic data. The recommendations by CUF were explored. Hospital utilization metrics were reviewed.
Results: Between September 2023 to November 2023, there were n=1738 callers. There was a statistically significant (p=.01) difference, whereby most patients (87.4%) contacting CUF were seen within the recommended time of care. Review of the 30-day period after triage call showed overall 95.7% of cases did not result in hospital utilization.
Conclusion: CUF has potential to be scaled to help improve care delivery for primary care practices by guiding patients for better access to the right level of care at the right time.
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.
