An initiative to improve documentation to meet the Centers for Disease Control and Prevention (CDC) recommendations for assessment of students who may be infected with STDs (sexually transmitted diseases); and a program to avoid abrupt fluctuations in blood sugar in patients with diabetes undergoing endoscopy procedures are winners of the 2011 Bernard A. Kershner Innovations in Quality Improvement Awards. The awards – one for surgical/procedural care and one for primary care – are given annually by the AAAHC Institute for Quality Improvement (AAAHC Institute), a not-for-profit subsidiary of the Accreditation Association for Ambulatory Health Care (AAAHC).
Honorable mention in the surgical/procedural category went to a program to enhance the process of informed consent and, in the primary care category, to an initiative to improve the evaluation and treatment of pharyngitis/tonsillitis.
The winners will present their studies and receive their awards at the AAAHC Institute’s 10th Annual National Educational Forum for Ambulatory Health Care, Dec. 3 – 4, 2011, at the Bellagio Hotel Resort and Casino in Las Vegas.
Improving STD Assessment in Health
The Award winner in the primary care category is the University Health Service, University of Michigan, Ann Arbor, for a QI initiative to improve the documentation of risk factors, discussion of HIV testing and prevention counseling in students requesting STD assessment, as recommended by the CDC.
In 2008, peer review of charts of patients seeking an STD assessment found high risk behaviors were not documented, condom use was recommended in 20 percent of cases and HIV testing was recommended in 50 percent of cases. Initial performance goals were set at 60 percent for each measure.
The QI program was conducted in six cycles of corrective action and re-measurement from May 2010 through May 2011. Corrective actions included the introduction of a template for assessing sexually transmitted infections, staff placement of the template in charts when STD assessments were requested, education to reinforce the importance of provider completion of the template, and provider self review to make sure the template was completed. Review of the data at the end of the six cycles found that assessment of risk factors and recommendation of condom use were documented in all cases, and HIV testing was discussed in 90 percent, according to Margaret Jacobs, MSN, RNC, ANP, quality improvement chairperson.
Controlling Blood Sugar Fluctuations in Patients with Diabetes
Do sedated endoscopy procedures cause significant fluctuations in blood sugar in diabetic patients and does the type of intravenous solution used affect fluctuations? These were the questions asked by staff at Elgin Gastroenterology Endoscopy Center (EGEC) in Elgin, IL in a quality improvement study that won the AAAHC Institute Award in the surgical/procedural category. Patients were divided into two groups: those that received intravenous solutions with dextrose (D5/0.9NS) and those that received solutions without dextrose (0.9NS). Blood sugar levels were measured before and after the procedures. The average change in blood sugar was 114.58 mg/dl in the dextrose group and -3.75 mg/dl in the no-dextrose group. As a result of the findings, the IV solution for all diabetic patients was changed to 0.9NS. After the change, the average blood sugar level was -1.4, according to Susan Theobold, RN, nurse manager, EGEC.
Runner-up in the primary care category was the University Health Services of the University of Texas at Austin for a program to improve the evaluation and treatment of pharyngitis/tonsillitis and avoid the overuse of antibiotics in patients with these diagnoses. Patient charts were reviewed in 2008. Following the review, evidence-based guidelines derived from the Centor Criteria and endorsed by the CDC in their “Principles of Appropriate Antibiotic Use” were implemented, electronic health record (EHR) processes were streamlined to improve documentation, and rapid strep testing was initiated. A subsequent review of patient data showed that antibiotic prescriptions at the initial patient visit decreased from 76 percent in 2008 to 46 percent in 2010.
The runner-up for the surgical/procedural category was a QI activity to improve performance in obtaining informed consents and documenting that a “time out” was performed prior to surgical procedures. Staff at Pinehurst Surgical Clinic, Pinehurst, NC, noticed variations in completing informed consents and documenting time outs among the 44 providers and seven specialties at the clinic. Performance in these areas was studied from September 2009 through December 2010. Policies and procedures were reviewed and revised and shared with staff, resulting in a significant improvement in performance at the end of the study period.
About the Awards
The Bernard A. Kershner Innovations in Quality Improvement Awards are given annually by the AAAHC Institute to recognize exemplary quality improvement activities of organizations accredited by the AAAHC.
The AAAHC Institute for Quality Improvement (AAAHC Institute) is among the few organizations to provide ambulatory care providers with the opportunities for benchmarking on a national level. The Accreditation Association established the AAAHC Institute in 1999 to provide ambulatory health care organizations opportunities to participate in quality improvement and performance measurement studies and educational programs. To date, the AAAHC Institute has conducted and published more than 60 performance measurement studies and has convened annual national educational forums on quality improvement in ambulatory health care. Involvement in clinical performance measurement is a signal to patients, government agencies, professional liability insurers, and third-party payers, that an ambulatory health organization is committed to continually improving the care it provides to its patients.
The Accreditation Association for Ambulatory Health Care (AAAHC/Accreditation Association), founded in 1979, is the leader in ambulatory health care accreditation with more than 5,000 organizations accredited nationwide. The AAAHC accredits a variety of ambulatory health care organizations, including ambulatory surgery centers, office-based surgery centers, college student health centers, managed care organizations, military health care clinics, large medical and dental practices and medical homes. In 2009, the Accreditation Association launched an international accreditation program in Costa Rica and will expand accreditation to other countries in the future. The AAAHC serves as an advocate for the provision of high-quality health care through the development of nationally recognized standards and through its survey and accreditation programs. AAAHC accreditation is recognized as a symbol of quality by third-party payers, medical organizations, liability insurance companies, state and federal agencies and the public. For more information visit www.aaahc.org.