Elizabeth Carreira, MBA, BSN, RN, CPPS, AMB-BC, NEA-BC | Rebecca DelleFave, MS, BSN, RN, Vice President, Chief Nursing Officer Ambulatory, Rochester Regional Health
Updated: 04/22/25
Updated: 04/22/25
The dismissal of patients from care in ambulatory care practice locations often results from behavioral concerns that oftentimes escalate to incidences of workplace violence. In August 2023, the organization identified a larger-than-expected volume of patient dismissals and a lack of standardized workflows surrounding processes related to patient dismissal through a review of patient grievance information. A multidisciplinary team was formed, led by nursing and executive medical leadership and inclusive of quality, regulatory, risk, legal, and social work. This team examined related processes across other specialties to manage complex patients to understand best practices.
A robust policy and procedure was developed in addition to an associated educational toolkit. The toolkit contains an outline of best practices that includes a newly developed patient responsibilities document, examples of scripting for difficult conversations, a behavioral contract template, examples of appropriate documentation, and a list of internal organizational resources. The toolkit also contains a decision guide for clinicians with two pathways, referral to the complex case committee for consult and request to the patient dismissal committee for consideration of dismissal. Both the complex case committee and dismissal committee were newly launched as part of the work to provide oversight and a framework for a standardized approach. The goal of this work was to promote local autonomy in managing difficult patient situations to improve patient outcomes through decreasing patient dismissals, decrease the legal and regulatory risks to the organization by ensuring thorough documentation as well as enhancing patient's likelihood to maintain a therapeutic relationship with the care team, and decrease incidences of workplace violence during in person, virtual, and telephonic encounters. Patient dismissals are tracked via an electronic health record report and incidences of workplace violence are tracked in the organization's event reporting system.
Since go-live, there has been a significant decrease in the number of patient dismissals from a high of 205 or 0.168% of total patients arrived for encounters in May 2023 to 62 or 0.0509% of total patients arrived in May 2024. Instances of workplace violence, threats, and incivility continue to be tracked in the organization's event reporting system and have demonstrated a decrease from 0.00794% in August 2023 to 0.00351% in April 2024.
Learners will gain insight into how the organization approached the management of complex patients in ambulatory care practices and how transparency, standardization, and education led to a significant decrease in patient dismissals as well as decrease in workplace violence.
A robust policy and procedure was developed in addition to an associated educational toolkit. The toolkit contains an outline of best practices that includes a newly developed patient responsibilities document, examples of scripting for difficult conversations, a behavioral contract template, examples of appropriate documentation, and a list of internal organizational resources. The toolkit also contains a decision guide for clinicians with two pathways, referral to the complex case committee for consult and request to the patient dismissal committee for consideration of dismissal. Both the complex case committee and dismissal committee were newly launched as part of the work to provide oversight and a framework for a standardized approach. The goal of this work was to promote local autonomy in managing difficult patient situations to improve patient outcomes through decreasing patient dismissals, decrease the legal and regulatory risks to the organization by ensuring thorough documentation as well as enhancing patient's likelihood to maintain a therapeutic relationship with the care team, and decrease incidences of workplace violence during in person, virtual, and telephonic encounters. Patient dismissals are tracked via an electronic health record report and incidences of workplace violence are tracked in the organization's event reporting system.
Since go-live, there has been a significant decrease in the number of patient dismissals from a high of 205 or 0.168% of total patients arrived for encounters in May 2023 to 62 or 0.0509% of total patients arrived in May 2024. Instances of workplace violence, threats, and incivility continue to be tracked in the organization's event reporting system and have demonstrated a decrease from 0.00794% in August 2023 to 0.00351% in April 2024.
Learners will gain insight into how the organization approached the management of complex patients in ambulatory care practices and how transparency, standardization, and education led to a significant decrease in patient dismissals as well as decrease in workplace violence.
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
Purpose: The purpose of the revised general internal medicine (GIM) nurse practice committee (NPC) was to improve nursing practice, patient experience, and nurse satisfaction under clinical nurse specialist (CNS) leadership and in collaboration with nurse managers (NMs) and GIM nurses. Dery et al. (2022) explored the optimization of nurses' enacted scope of practice as a strategy for improving clinical performance. New processes and resources that support full nursing scope of practice were developed. This project demonstrates that strategies focused on engaging clinical nurses can improve nursing practice.
Description: GIM ambulatory care nursing is complex and diverse and consists of registered nurses and licensed practical nurses, general and specialty care, and onsite and virtual care. The NPC experienced a lack of structure and unclear role expectations contributing to nurse disengagement. Leadership strategies to enhance nursing staff engagement are critical for improving performance. CNSs are educationally prepared to address gaps and improve patient outcomes in ambulatory care and within complex healthcare systems. Gaps exist in the literature regarding structure and design of a clinical nurse-led ambulatory care nurse practice committee. The objectives were to develop a new process to identify and resolve practice issues and identify strategies to build staff engagement. Clarification of committee role expectations, orientation to committee roles, and a targeted marketing strategy were developed to build engagement. A process was created to submit suggestions for practice changes electronically by situation, background, assessment, and recommendation (SBAR) format. Changes are addressed in three ways, among clinical nurses and managers, via a practice area workgroup, or via a multispecialty practice workgroup. Practice changes are shared with the GIM team by bidirectional communication and shared governance.
Evaluation/outcome: The redesigned GIM NPC membership consists of seven staff nurses in leadership roles as liaisons to clinical areas. The CNS and NMs serve as leadership advisors. In one year, nurses submitted 12 SBARs and completed nine SBARs, resulting in the development of electronic health record (EHR) nurse super users as a technology resource and a B12 administration toolkit supporting LPN administration, nurse engagement, and enhanced patient education. A multispecialty practice workgroup revised ambulatory care nurse education visits, conducted GIM emergency medical response training, and designed three interfacing digital platforms to store and provide access to resources. The GIM NPC promotes nurse engagement by building a culture of bi-directional communication, promoting nurse-driven ideas and solutions, and supporting GIM nurse and leadership partnerships to improve nursing practice, patient experience, and nurse satisfaction.
Description: GIM ambulatory care nursing is complex and diverse and consists of registered nurses and licensed practical nurses, general and specialty care, and onsite and virtual care. The NPC experienced a lack of structure and unclear role expectations contributing to nurse disengagement. Leadership strategies to enhance nursing staff engagement are critical for improving performance. CNSs are educationally prepared to address gaps and improve patient outcomes in ambulatory care and within complex healthcare systems. Gaps exist in the literature regarding structure and design of a clinical nurse-led ambulatory care nurse practice committee. The objectives were to develop a new process to identify and resolve practice issues and identify strategies to build staff engagement. Clarification of committee role expectations, orientation to committee roles, and a targeted marketing strategy were developed to build engagement. A process was created to submit suggestions for practice changes electronically by situation, background, assessment, and recommendation (SBAR) format. Changes are addressed in three ways, among clinical nurses and managers, via a practice area workgroup, or via a multispecialty practice workgroup. Practice changes are shared with the GIM team by bidirectional communication and shared governance.
Evaluation/outcome: The redesigned GIM NPC membership consists of seven staff nurses in leadership roles as liaisons to clinical areas. The CNS and NMs serve as leadership advisors. In one year, nurses submitted 12 SBARs and completed nine SBARs, resulting in the development of electronic health record (EHR) nurse super users as a technology resource and a B12 administration toolkit supporting LPN administration, nurse engagement, and enhanced patient education. A multispecialty practice workgroup revised ambulatory care nurse education visits, conducted GIM emergency medical response training, and designed three interfacing digital platforms to store and provide access to resources. The GIM NPC promotes nurse engagement by building a culture of bi-directional communication, promoting nurse-driven ideas and solutions, and supporting GIM nurse and leadership partnerships to improve nursing practice, patient experience, and nurse satisfaction.
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: 05/18/25
Updated: 05/18/25
Introduction: Influenza results in significant pediatric illness, hospitalization, and mortality. During the 2022-2023 season, 106 pediatric influenza-associated deaths were reported in the United States. Half of those deaths were in healthy children without medical conditions, and 90% occurred in unvaccinated children. The Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP) consequently recommend influenza vaccination during all healthcare encounters including the perioperative period.
The purpose of this quality improvement evaluation is to increase seasonal influenza vaccination volume in our pediatric population by offering vaccination while under anesthesia. Target population includes children aged 6 months to 18 years undergoing procedure or surgery at our facility. Target dates include September 2023 through April 2024.
Methods; After approval from the research determination office, dedicated members of a multidisciplinary perioperative team, including providers, leaders, nurses, physicians, and pharmacists, developed our perioperative pediatric influenza vaccination program to address the urgency of action aimed at increasing influenza vaccination rates during the 2023-2024 season.
Results: Perioperative services provided over 200 pediatric patients with protective influenza vaccination from September 2023 to April 2024. The volume of patients during the same period is 970. Post-intervention, we demonstrated a 21% pediatric influenza vaccination capture during our inaugural season.
Conclusions: The perioperative period is a prime opportunity to increase pediatric influenza vaccinations without the experience of injection. Perioperative services has expanded the program, offering vaccine to developmentally challenged adults, to support delivery of socially sensitive care.
The program can be replicated with overall goal to increase pediatric vaccination rates and improve the health in our communities, all while reducing the stress experience of injection. Perioperative services in the ambulatory care setting has a unique opportunity to support this vulnerable population.
The purpose of this quality improvement evaluation is to increase seasonal influenza vaccination volume in our pediatric population by offering vaccination while under anesthesia. Target population includes children aged 6 months to 18 years undergoing procedure or surgery at our facility. Target dates include September 2023 through April 2024.
Methods; After approval from the research determination office, dedicated members of a multidisciplinary perioperative team, including providers, leaders, nurses, physicians, and pharmacists, developed our perioperative pediatric influenza vaccination program to address the urgency of action aimed at increasing influenza vaccination rates during the 2023-2024 season.
Results: Perioperative services provided over 200 pediatric patients with protective influenza vaccination from September 2023 to April 2024. The volume of patients during the same period is 970. Post-intervention, we demonstrated a 21% pediatric influenza vaccination capture during our inaugural season.
Conclusions: The perioperative period is a prime opportunity to increase pediatric influenza vaccinations without the experience of injection. Perioperative services has expanded the program, offering vaccine to developmentally challenged adults, to support delivery of socially sensitive care.
The program can be replicated with overall goal to increase pediatric vaccination rates and improve the health in our communities, all while reducing the stress experience of injection. Perioperative services in the ambulatory care setting has a unique opportunity to support this vulnerable population.
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.
Patricia Gray, MSN, RN, Assistant Patient Service Manager, Yale New Haven Hospital | Kim Trotta, MSN, RN, CNML, Patient Service Manager, Yale New Haven Hospital
Updated: 05/08/25
Updated: 04/22/25
The identification of suicide risk in pediatric patients is a growing concern in ambulatory care. According to the CDC in 2022, suicide was the second leading cause of death for ages 10-14. At Yale New Haven Children’s Hospital Pediatric Specialty Centers (PSC), comprising of seven sites across Connecticut, our goal was to develop a standardized screening process to identify adolescents at risk.
Over the past 5 years in PSC, 70k children aged 12 years or older have been screened for depression utilizing the patient health questionnaire (PHQ). We have made many changes to optimize the workflow. Previously reliant on paper and verbal assessments, the screening process evolved to integrate confidential iPad technology, allowing adolescents to self-report sensitive information with greater privacy. Our iPad initiative was introduced in May 2024. This technological innovation has transformed the screening process, enabling earlier identification and intervention for at-risk adolescents.
With each change, a collaborative interdisciplinary team including clinical nurse leaders, educators, social workers, and IT specialists conducted a thorough review of the screening process. While the PHQ-9 tool effectively screened for depression, it was determined that a more comprehensive evaluation was necessary for assessing suicide risk. As a result, the Columbia Suicide Severity Rating Scale (CSSRS) was integrated into the workflow. Nurses were trained to administer the CSSRS, and an algorithm was developed to guide care planning for patients identified as at risk.
Adolescents flagged through the screening process undergo a complete suicide risk assessment by a licensed SW, who recommends further evaluation, treatment, or psychiatric admission. Telehealth technology was implemented to address SW resource limitations ensuring that patients identified at risk, regardless of their clinic location, receive timely, comprehensive risk assessments. Telehealth capabilities provide equitable access to mental health care across all pediatric ambulatory care specialty sites, ensuring a standardized approach to care.
The iPad technology significantly enhances patient safety by increasing reliability while maintaining confidentiality. Integrating self-administered screenings allows adolescents to self-report sensitive information with greater privacy. This initiative exemplifies how leveraging technology in clinical settings can improve outcomes for at-risk youth. Implementing the iPad questionnaire resulted in 236% increase in positive screenings and a 343% rise to question nine of the PHQ-9, indicating improved patient reliability. Identifying patients earlier enables us to provide immediate intervention such as additional resources, referral to the crisis hotline or a psychiatric evaluation.
This effort has empowered pediatric ambulatory care nurses to play a critical role in identifying and escalating care for at-risk patients. With improved reliability of PHQ-9 screening process and seamless integration of technology, nurses are now equipped to coordinate timely interventions and facilitate access to treatment. The integration of validated tools, technology, and training ensures early identification ultimately aiming to save lives and provide mental health resources. This collaborative approach ensures that adolescents in the ambulatory care setting receive the care they need while maintaining patient confidentiality and standardizing the quality of care across sites. The process not only enhances patient safety but also strengthens the role of ambulatory care nurses in providing holistic, patient-centered care.
Over the past 5 years in PSC, 70k children aged 12 years or older have been screened for depression utilizing the patient health questionnaire (PHQ). We have made many changes to optimize the workflow. Previously reliant on paper and verbal assessments, the screening process evolved to integrate confidential iPad technology, allowing adolescents to self-report sensitive information with greater privacy. Our iPad initiative was introduced in May 2024. This technological innovation has transformed the screening process, enabling earlier identification and intervention for at-risk adolescents.
With each change, a collaborative interdisciplinary team including clinical nurse leaders, educators, social workers, and IT specialists conducted a thorough review of the screening process. While the PHQ-9 tool effectively screened for depression, it was determined that a more comprehensive evaluation was necessary for assessing suicide risk. As a result, the Columbia Suicide Severity Rating Scale (CSSRS) was integrated into the workflow. Nurses were trained to administer the CSSRS, and an algorithm was developed to guide care planning for patients identified as at risk.
Adolescents flagged through the screening process undergo a complete suicide risk assessment by a licensed SW, who recommends further evaluation, treatment, or psychiatric admission. Telehealth technology was implemented to address SW resource limitations ensuring that patients identified at risk, regardless of their clinic location, receive timely, comprehensive risk assessments. Telehealth capabilities provide equitable access to mental health care across all pediatric ambulatory care specialty sites, ensuring a standardized approach to care.
The iPad technology significantly enhances patient safety by increasing reliability while maintaining confidentiality. Integrating self-administered screenings allows adolescents to self-report sensitive information with greater privacy. This initiative exemplifies how leveraging technology in clinical settings can improve outcomes for at-risk youth. Implementing the iPad questionnaire resulted in 236% increase in positive screenings and a 343% rise to question nine of the PHQ-9, indicating improved patient reliability. Identifying patients earlier enables us to provide immediate intervention such as additional resources, referral to the crisis hotline or a psychiatric evaluation.
This effort has empowered pediatric ambulatory care nurses to play a critical role in identifying and escalating care for at-risk patients. With improved reliability of PHQ-9 screening process and seamless integration of technology, nurses are now equipped to coordinate timely interventions and facilitate access to treatment. The integration of validated tools, technology, and training ensures early identification ultimately aiming to save lives and provide mental health resources. This collaborative approach ensures that adolescents in the ambulatory care setting receive the care they need while maintaining patient confidentiality and standardizing the quality of care across sites. The process not only enhances patient safety but also strengthens the role of ambulatory care nurses in providing holistic, patient-centered care.
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
Purpose: Doxycycline post-exposure prophylaxis (DoxyPEP) is an emerging strategy for preventing sexually transmitted infections (STIs) in high-risk populations, such as men who have sex with men (MSM), commercial sex workers, and individuals with multiple sexual partners. A registered nurse (RN)-led initiative was launched to streamline the DoxyPEP process within the ambulatory care setting of a metropolitan teaching hospital's primary care clinic. The RN conducted a root cause analysis and identified three critical areas for improvement: physician knowledge sharing, standardization of electronic prescriptions, and enhancement of patient teaching materials. The project's aim was to address these issues and close existing gaps in care pathways.
Description: The implementation of the streamlined process followed the plan-do-study-act (PDSA) framework over one year and included monthly stakeholder meetings to track progress. In the first quarter, the clinic hosted Professor Dr. DoMarco from the University of Rochester, the project investigator behind the New York PrEP guidelines, to educate clinic providers and disseminate valuable insights.
In the second quarter, the care team collaborated with the Epic team to standardize DoxyPEP prescriptions, ensuring that all instructions were clear and precise. The third quarter focused on creating educational materials with the patient education staff, producing resources at a 10th-grade reading level. These materials included infographics and were made available in both English and Spanish to enhance patient comprehension.
Evaluation: By the fourth quarter, the care team reported a remarkable 100% patient satisfaction rate for DoxyPEP consultations, a significant increase from the 65% satisfaction rate observed prior to the intervention. The streamlined DoxyPEP process markedly improved patient safety regarding STI prevention and contributed to public health initiatives aimed at reducing STI infection rates. Additionally, the initiative projected savings of $120,000 per month in treatment and consultations at the local community level, underscoring the necessity of broadening STI prevention tools across public health initiatives.
Conclusion: The outcomes of this project underscore the effectiveness of systematic improvements in healthcare delivery, particularly for critical interventions like DoxyPEP. By ensuring that high-risk populations receive adequate care and education, the initiative not only enhances patient safety and satisfaction but also promotes broader public health objectives. Expanding access to effective STI prevention strategies is essential for mitigating infection rates and fostering healthier communities.
Description: The implementation of the streamlined process followed the plan-do-study-act (PDSA) framework over one year and included monthly stakeholder meetings to track progress. In the first quarter, the clinic hosted Professor Dr. DoMarco from the University of Rochester, the project investigator behind the New York PrEP guidelines, to educate clinic providers and disseminate valuable insights.
In the second quarter, the care team collaborated with the Epic team to standardize DoxyPEP prescriptions, ensuring that all instructions were clear and precise. The third quarter focused on creating educational materials with the patient education staff, producing resources at a 10th-grade reading level. These materials included infographics and were made available in both English and Spanish to enhance patient comprehension.
Evaluation: By the fourth quarter, the care team reported a remarkable 100% patient satisfaction rate for DoxyPEP consultations, a significant increase from the 65% satisfaction rate observed prior to the intervention. The streamlined DoxyPEP process markedly improved patient safety regarding STI prevention and contributed to public health initiatives aimed at reducing STI infection rates. Additionally, the initiative projected savings of $120,000 per month in treatment and consultations at the local community level, underscoring the necessity of broadening STI prevention tools across public health initiatives.
Conclusion: The outcomes of this project underscore the effectiveness of systematic improvements in healthcare delivery, particularly for critical interventions like DoxyPEP. By ensuring that high-risk populations receive adequate care and education, the initiative not only enhances patient safety and satisfaction but also promotes broader public health objectives. Expanding access to effective STI prevention strategies is essential for mitigating infection rates and fostering healthier 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.
Beckie Kronebusch, MS, APRN, AGCNS-BC, Advanced Practice Registered Nurse, Mayo Clinic
Updated: 04/22/25
Updated: 04/22/25
Background: Wounds create a personal burden to individual health and quality of life, while also creating an economic cost and toll on the healthcare system. In a midwestern community health system primary care practice, 69% of regional clinic nursing staff at eight sites see patients for wound care once a week and up to several times weekly. There are variations in wound care products and processes at each of the sites, as well as disparities in the knowledge of staff regarding identification and care of wounds, the importance of photographing wounds, location of wound care resources, and documentation and billing resulting in variable patient outcomes.
Purpose: To improve nursing wound care processes across a regional primary care practice.
Methods: The DMAIC (define, measure, analyze, improve, and control) quality improvement framework was used with interdisciplinary team members to impact wound care in community primary care settings. Pre- and post-intervention surveys of nursing staff were completed to measure improvement. Stakeholders were assessed to be inclusive of all team members’ needs. Root causes were determined by the team and assessed for the greatest impact before implementing. Processes were clarified and a toolkit for wound care in primary care was created and this was presented along with streamlined education to staff.
Results: The main findings from the surveys, root cause analysis, and team discussions were the need to improve wound photography processes, wound and care-appropriate product identification, accessible wound care resources, and documentation standardization. Overall, there was a 31% improvement in reported confidence of identification of different types of wounds and ability to find resources for wound care, products, and contacts and choose the proper treatment for different types of wounds.
Implications for practice: Nurses engaged in their practice and quality improvement present the best opportunity to impact patient outcomes. This project was brought forward by staff excited about improving care for their patients. Wound care is an overall gap for outpatient care teams expected to provide high quality care. This project supported staff needs and ultimately impacted patient outcomes and can inform for others that may need to enhance wound care practices in primary or other ambulatory care areas.
Purpose: To improve nursing wound care processes across a regional primary care practice.
Methods: The DMAIC (define, measure, analyze, improve, and control) quality improvement framework was used with interdisciplinary team members to impact wound care in community primary care settings. Pre- and post-intervention surveys of nursing staff were completed to measure improvement. Stakeholders were assessed to be inclusive of all team members’ needs. Root causes were determined by the team and assessed for the greatest impact before implementing. Processes were clarified and a toolkit for wound care in primary care was created and this was presented along with streamlined education to staff.
Results: The main findings from the surveys, root cause analysis, and team discussions were the need to improve wound photography processes, wound and care-appropriate product identification, accessible wound care resources, and documentation standardization. Overall, there was a 31% improvement in reported confidence of identification of different types of wounds and ability to find resources for wound care, products, and contacts and choose the proper treatment for different types of wounds.
Implications for practice: Nurses engaged in their practice and quality improvement present the best opportunity to impact patient outcomes. This project was brought forward by staff excited about improving care for their patients. Wound care is an overall gap for outpatient care teams expected to provide high quality care. This project supported staff needs and ultimately impacted patient outcomes and can inform for others that may need to enhance wound care practices in primary or other ambulatory care areas.
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
Health equity exists when all people, regardless of race, sex, sexual orientation, disability, socio-economic status, geographic location, or other societal constructs, have fair and just access, opportunity, and resources to achieve their highest potential for health. Unfortunately, social and political determinants of health negatively affect many communities, their people, and their ability to lead healthy lives. In 2020, 10.5% of the United States population reported food insecurity. This is approximately 38.3 million people annually experiencing inconsistent or lack of access to food.
To meet the needs of this underserved population, several network clinics collaborated with a local food bank to create wellness pantries to provide sustenance to families until a consistent food source can be secured through a referral to the food bank and the supplemental nutrition assistance program (SNAP). Since the inception of the first two wellness pantries in October 2021, a third was added in February 2022 and fourth in November 2022. The operational goal is to have wellness pantries located in all organization clinic locations. To date, the four operating wellness pantries have distributed 30,590 pounds of food to over 1,000 families. The program has an immediate impact on the well-being of the rural population.
The impact that food insecurity has on an individual’s health magnifies the need to provide sustainable food to individuals in need. Adults suffering from food insecurity have a great risk of obesity chronic disease. Children are also impacted as there is a higher likelihood of developmental problems among children who suffer from food insecurity. Healthcare facilities have the opportunity to make a significant impact by utilizing touch points during a patient’s visit to improve food insecurity in rural locations. The collaboration between food banks and healthcare facilities can provide a model the substantial impact health facilities can have on the population they serve.
This established program has an immediate impact on addressing the food insecurity crisis that we are facing. This is an opportunity for other facilities to copy this blueprint and make the same impact in their communities.
Objectives: Understand the state of food insecurity in rural populations. Identify the actions taken to implement wellness pantries in the healthcare setting. Improve population health with knowledge gained to implement food pantry in learners’ area.
To meet the needs of this underserved population, several network clinics collaborated with a local food bank to create wellness pantries to provide sustenance to families until a consistent food source can be secured through a referral to the food bank and the supplemental nutrition assistance program (SNAP). Since the inception of the first two wellness pantries in October 2021, a third was added in February 2022 and fourth in November 2022. The operational goal is to have wellness pantries located in all organization clinic locations. To date, the four operating wellness pantries have distributed 30,590 pounds of food to over 1,000 families. The program has an immediate impact on the well-being of the rural population.
The impact that food insecurity has on an individual’s health magnifies the need to provide sustainable food to individuals in need. Adults suffering from food insecurity have a great risk of obesity chronic disease. Children are also impacted as there is a higher likelihood of developmental problems among children who suffer from food insecurity. Healthcare facilities have the opportunity to make a significant impact by utilizing touch points during a patient’s visit to improve food insecurity in rural locations. The collaboration between food banks and healthcare facilities can provide a model the substantial impact health facilities can have on the population they serve.
This established program has an immediate impact on addressing the food insecurity crisis that we are facing. This is an opportunity for other facilities to copy this blueprint and make the same impact in their communities.
Objectives: Understand the state of food insecurity in rural populations. Identify the actions taken to implement wellness pantries in the healthcare setting. Improve population health with knowledge gained to implement food pantry in learners’ area.
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 outcome: Understand how to create and implement a medical assistant training program to meet ambulatory care workforce needs.
Background: Medical assistants (MAs) provide clinical support in ambulatory care offices and play a crucial role in patient care. An organization identified an increased workforce need within ambulatory care offices due to a minimal number of MA graduates in the community. Approximately 50% of all new MA hires were leaving the organization within the first six months of employment due to a lack of career readiness. The executive leadership team envisioned building an MA training program to standardize training and meet the ambulatory care workforce needs of the medical group. The leadership team hired an experienced clinical nurse educator to develop and implement an internal MA training program.
Purpose: The purpose of developing and implementing a full-time paid MA training program was to meet workforce needs, increase the career readiness of new MAs and employee retention rates, and provide quality ambulatory care services to the community. Building a sustainable workforce that can support growth of the healthcare organization has the potential to improve patient access to care in underserved areas.
Methods: The development of the MA training program required an in-depth evaluation of MAs throughout all ambulatory care service lines. The program was designed to be an accelerated program with educational material focused on career readiness for an entry level MA that could be employed in any ambulatory care specialty office. The organization hired internal and external candidates into the MA program who may have little to no medical background. Education was presented using multiple modalities and consists of didactic education, skills training, and clinical experiences.
Outcomes: The MA program began in May of 2020 and has graduated a total of 561 MAs. It has become the primary source of new MA employees, MA retention rates have improved, and ambulatory care services have expanded to underserved communities. One-year retention rates average 78% and two-year retention rates average 67%. Higher retention rates occur with internal employees who join the MA program and are most likely due to organizational loyalty and prior exposure to health care. There have been 16 graduates from the program who have continued their education by obtaining their limited medical radiography (LMR) license. There have been seven graduates who have grown in their career to become nurses within the organization. Five graduates have moved into ambulatory care leadership roles. The creation of an internal MA training program has proven to be an effective way to meet workforce needs, support the mission of the organization, and allow for employee professional growth.
Implications: Flexibility during the implementation phase was needed to ensure meaningful changes were made to the program through collaborative partnerships with ambulatory care leadership, experienced clinical staff, executive leadership, and talent acquisition. A lack of data collection ability made it challenging to make direct correlations between education and patient outcomes. Looking toward the future, the success of the program may be used to help support the creation of other allied health training programs within the organization.
Background: Medical assistants (MAs) provide clinical support in ambulatory care offices and play a crucial role in patient care. An organization identified an increased workforce need within ambulatory care offices due to a minimal number of MA graduates in the community. Approximately 50% of all new MA hires were leaving the organization within the first six months of employment due to a lack of career readiness. The executive leadership team envisioned building an MA training program to standardize training and meet the ambulatory care workforce needs of the medical group. The leadership team hired an experienced clinical nurse educator to develop and implement an internal MA training program.
Purpose: The purpose of developing and implementing a full-time paid MA training program was to meet workforce needs, increase the career readiness of new MAs and employee retention rates, and provide quality ambulatory care services to the community. Building a sustainable workforce that can support growth of the healthcare organization has the potential to improve patient access to care in underserved areas.
Methods: The development of the MA training program required an in-depth evaluation of MAs throughout all ambulatory care service lines. The program was designed to be an accelerated program with educational material focused on career readiness for an entry level MA that could be employed in any ambulatory care specialty office. The organization hired internal and external candidates into the MA program who may have little to no medical background. Education was presented using multiple modalities and consists of didactic education, skills training, and clinical experiences.
Outcomes: The MA program began in May of 2020 and has graduated a total of 561 MAs. It has become the primary source of new MA employees, MA retention rates have improved, and ambulatory care services have expanded to underserved communities. One-year retention rates average 78% and two-year retention rates average 67%. Higher retention rates occur with internal employees who join the MA program and are most likely due to organizational loyalty and prior exposure to health care. There have been 16 graduates from the program who have continued their education by obtaining their limited medical radiography (LMR) license. There have been seven graduates who have grown in their career to become nurses within the organization. Five graduates have moved into ambulatory care leadership roles. The creation of an internal MA training program has proven to be an effective way to meet workforce needs, support the mission of the organization, and allow for employee professional growth.
Implications: Flexibility during the implementation phase was needed to ensure meaningful changes were made to the program through collaborative partnerships with ambulatory care leadership, experienced clinical staff, executive leadership, and talent acquisition. A lack of data collection ability made it challenging to make direct correlations between education and patient outcomes. Looking toward the future, the success of the program may be used to help support the creation of other allied health training programs within the organization.
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.
Sandra Spence, DNP, MSN, RN, Ambulatory Care Clinical and Simulation Coordinator, Emory University
Updated: 04/22/25
Updated: 04/22/25
Background: Post-renal transplant education plays a pivotal role in the success of renal transplantation by empowering recipients with the understanding and knowledge needed to manage their renal health post-transplantation. Evidence indicates that patients who lack an understanding of immunosuppressive medication, dietary restrictions, and signs of graft rejection are at an increased risk of complications, hospitalization, and/or loss of graft. Even without specific complications, inadequate education and non-adherence to prescribed plans remain significant barriers to achieving optimal patient outcomes. In a large southeastern medical center outpatient transplant clinic, it was estimated that 20-25% of the patients were confused about the required lifestyle changes they needed to make. With the lack of educational curriculum reinforcement in post-renal transplant patients, a higher number of post-renal transplant rejections occur within the first three months post-transplantation. There is no transplant educator in the outpatient clinic, resulting in little to no reinforcement of the educational curriculum the recipients received when they were inpatients. During post-renal transplant clinic visits, it was noted that many patients were overwhelmed with information they received immediately post-operatively. Clarification of lab values, medications, and diet considerations needed to be readdressed. Many of the transplant recipients had been on dialysis for years and it was evident that they were struggling to comprehend this new way of life.
Objective: The purpose of this project was to improve renal transplant recipients’ health and lifestyle knowledge through targeted reinforcement of post-renal transplant education.
Methods: Within three months after the inpatient education phase of renal transplant, the kidney understanding tool (K-TUT) 25-question survey was administered to renal transplant recipients to assess their knowledge of post-renal transplant health. The survey took approximately 30 minutes to complete. Following the survey, patients received written educational material including targeted information based on the participant’s K-TUT score and an online presentation via Zoom. After the educational sessions, the K-TUT survey was repeated to evaluate the intervention.
Demographic information: The target population was patients over the age of 21 years who received a kidney transplant within three months. 33 patients were screened; 13 completed all phases of the project.
Analysis: Pre- and post-intervention scores were analyzed for changes in understanding and level of confidence in initiating lifestyle changes. Descriptive and inferential statistical tests (T-test and Pearson’s correlation) were used to analyze pre- and post-survey scores.
Results: The pre-survey scores showed a mean of 76.6, and post-survey scores had a mean of 83.7, with a p-value of 0.001. The results indicate that renal transplant patients who received reinforcement of education showed an improvement in knowledge to make essential lifestyle changes.
Conclusion: The educational intervention successfully reinforced renal health knowledge for post-renal transplant recipients who were less than three months post-transplantation. The clinic nurses could incorporate reinforcing information that was indicated on the K-TUT survey.
Objective: The purpose of this project was to improve renal transplant recipients’ health and lifestyle knowledge through targeted reinforcement of post-renal transplant education.
Methods: Within three months after the inpatient education phase of renal transplant, the kidney understanding tool (K-TUT) 25-question survey was administered to renal transplant recipients to assess their knowledge of post-renal transplant health. The survey took approximately 30 minutes to complete. Following the survey, patients received written educational material including targeted information based on the participant’s K-TUT score and an online presentation via Zoom. After the educational sessions, the K-TUT survey was repeated to evaluate the intervention.
Demographic information: The target population was patients over the age of 21 years who received a kidney transplant within three months. 33 patients were screened; 13 completed all phases of the project.
Analysis: Pre- and post-intervention scores were analyzed for changes in understanding and level of confidence in initiating lifestyle changes. Descriptive and inferential statistical tests (T-test and Pearson’s correlation) were used to analyze pre- and post-survey scores.
Results: The pre-survey scores showed a mean of 76.6, and post-survey scores had a mean of 83.7, with a p-value of 0.001. The results indicate that renal transplant patients who received reinforcement of education showed an improvement in knowledge to make essential lifestyle changes.
Conclusion: The educational intervention successfully reinforced renal health knowledge for post-renal transplant recipients who were less than three months post-transplantation. The clinic nurses could incorporate reinforcing information that was indicated on the K-TUT survey.
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.
Joni Anderson, MSN, RN | Amy Gittins, BHA, BSN, RN, NE-BC | Rachel Loveless, MSN, RN | Shannon Peterson, MSN, RN
Updated: 04/22/25
Updated: 04/22/25
Purpose: Develop a performance-based progression program that is designed to retain medical assistants. This is achieved by recognition of excellence in engagement, clinical skills, and leadership opportunities.
Background: Previous medical assistant (MA) advancement was only achieved by years of service and did not require additional learning or growth opportunities to support their clinics. Clinic leaders needed structure to allow for super user and champion roles to support the work to ensure their clinics were successful.
Methods: Our development journey included the following items: Organize teams to create progression structure. Nursing and MA leaders had front-line MAs review the structure for ideas. Create 3 pathways from MA resident, MA, and MA senior. Each pathway has requirements that are needed to advance to the next pathway. Develop a review period to allow for twice-a-year advancement (April and October). Clinic managers and nursing leaders are to sign off to ensure requirements are being met. MA certification is required for MA seniors to allow for growth in knowledge of MA skills. Develop a fillable form that follows caregivers to track their progress.
Results: We are in our third year since implementation and are seeing positive results by recognizing the extra work that is needed to create a safe and high-quality environment for positive patient outcomes. The new structure also provides professional growth as a medical assistant.
Conclusion: The use of the new MA progression process sets the stage for Intermountain Health to continue to improve the patient experience by providing stronger engagement and leadership opportunities for our medical assistants, which leads to safer outcomes.
Background: Previous medical assistant (MA) advancement was only achieved by years of service and did not require additional learning or growth opportunities to support their clinics. Clinic leaders needed structure to allow for super user and champion roles to support the work to ensure their clinics were successful.
Methods: Our development journey included the following items: Organize teams to create progression structure. Nursing and MA leaders had front-line MAs review the structure for ideas. Create 3 pathways from MA resident, MA, and MA senior. Each pathway has requirements that are needed to advance to the next pathway. Develop a review period to allow for twice-a-year advancement (April and October). Clinic managers and nursing leaders are to sign off to ensure requirements are being met. MA certification is required for MA seniors to allow for growth in knowledge of MA skills. Develop a fillable form that follows caregivers to track their progress.
Results: We are in our third year since implementation and are seeing positive results by recognizing the extra work that is needed to create a safe and high-quality environment for positive patient outcomes. The new structure also provides professional growth as a medical assistant.
Conclusion: The use of the new MA progression process sets the stage for Intermountain Health to continue to improve the patient experience by providing stronger engagement and leadership opportunities for our medical assistants, which leads to safer 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.
