The Accreditation Association for Ambulatory Health Care (AAAHC) recognized the University of Utah Student Health Center and the PAMF Surgery Center Fremont as winners of its annual quality improvement award. This award recognizes AAAHC-accredited organizations for exemplary quality improvement studies in areas of primary care and surgical/procedural care.
The award – named for Bernard A. Kershner, a leader in ambulatory healthcare and distinguished past chair of the AAAHC Institute board of trustees – was presented to representatives from the winning organizations at the 2017 Achieving Accreditation conference March 18 in Tampa, Fla.
AAAHC-accredited organizations were invited to submit detailed descriptions of completed quality improvement studies, and three finalists in each category were identified from the submissions.
In the primary care category, the University of Utah Student Health Center implemented a comprehensive improvement study to increase human papillomavirus (HPV) vaccination rates among male college students through the use of electronic medical record (EMR) alerts. The surgical/procedural care winner, PAMF Surgery Center Fremont, conducted an improvement study to increase operating room turnover efficiency and shorten turnover times.
“The Kershner Awards showcase innovative quality improvement studies that have achieved measurable advancement to meet or exceed a defined goal,” said Naomi Kuznets, PhD, vice president and senior director for AAAHC Institute. “The AAAHC Institute takes great pride in recognizing this year’s winners for their creativity and collaborative approaches to QI.”
2016-17 Primary Care Winner
“Increasing Human Papillomavirus (HPV) Vaccination Rates”
University of Utah Student Health Center
Salt Lake City, Utah
The Challenge: According to the CDC, 75 percent of sexually-active people acquire HPV, most often as teens or young adults. College students may qualify for catch-up HPV vaccinations, but many male college students are unaware they may qualify for the HPV vaccine. In addition, many health care providers forget to offer the HPV vaccine at routine visits, leading to missed opportunities. The goal of this study was to have 20 percent of males with a scheduled visit receive one or more doses of the HPV vaccine.
The Solution: To help meet the goal, the University of Utah Student Health Center adopted computer-automated alerts through its EMR system. When a male patient entered the student health center system, he would be screened for HPV vaccination eligibility. If eligible, an alert would be set up in his EMR to remind providers to discuss the vaccine during consultations. If the patient declined the vaccine, the alert would be removed. If the patient wanted to consider the vaccine, it would stay in his EMR until he received the vaccine or eventually declined. The alert would remind providers of the vaccine eligibility each time the patient record was accessed. Staff underwent training on how to use and respond to the EMR alert, as well as how to field questions from patients.
The Result: The student health center calculated the percentage of participants who received at least one dose of the HPV vaccine at a scheduled visit and found 25.1 percent of participants received the vaccine during the post-alert period, which surpassed the goal of 20 percent.
2016-17 Surgical/Procedural Care
“The O.R. Pit Crew: A NASCAR Template for O.R. Efficiency”
PAMF Surgical Center Fremont
The Challenge: Fast and efficient turnovers improve the experience for staff members, doctors and patients. When turnovers are efficient, there is high staff, provider and patient satisfaction; increased center productivity; and effective use of resources. The surgical center was experiencing extended turnover times that decreased overall efficiency. The goal of the study was to achieve and maintain an average turnover time of 15 minutes or less.
The Solution: Turnover times were tracked on a daily basis by the center’s Patient Traffic Controller using a data collection tool, which included a record of delay reasons for each turnover. The data collection tool was displayed for O.R. team member discussion to continuously manage improvements. Frontline employees from the operating room, sterile processing, admissions and leadership held brainstorming sessions to identify causes and solutions for extended turnover times.
Based on the identified opportunities for improvement, the work group developed and adopted the NASCAR Pit Crew Model that assigns specific roles during turnovers to team members. While the team members can be interchangeable within the “crew,” the roles remain static. By creating specific roles and tasks for team members to step into during a turnover, the center experienced improved communication and trust, decreased confusion and questions regarding turnover, maximized resources, and reduced waste and time spent.
Thirty days after implementation, the average turnover time was 17.8 minutes, just over the 15 minute goal, but an improvement from an average 22.5 minutes measured at the start of the study. The center identified two other causes for extended turnover times: regional blocks in pre-op and extended instrument turnover times. In response, regional blocks were added to the surgical schedule to allow for additional prep time, while a “Pink Card System” was implemented to identify which instruments will be required for the next patient so they are ready faster. In addition, the center budgeted to purchase more instruments in the following fiscal cycle.
The Result: The O.R. Pit Crew model led to a 22 percent reduction in turnover time, dropping from 22.5 minutes to 17.6 minutes. Daily engagement huddles provide ongoing opportunities for staff to discuss turnover times, walk through issues and offer suggestions. Continuing team practice and enthusiasm for the solution ultimately resulted in an average turn-over of under 15 minutes, meeting the goal.
Of the quality improvement study submissions, the following were deemed finalists for the Kershner Award.
2016-17 Primary Care
• “An Intervention to Reduce Unnecessary TSH, HbA1c and Vitamin D Testing in Accordance with Evidence Based Guidelines within a PCMH”
Premise Health Westlake Health & Wellness Center
• “A Multidisciplinary Approach to Condition Management in a Primary Care Setting”
Premise Health Center for Living Well Family Healthcare
Lake Buena Vista, Fla.
2016-17 Surgical /Procedural Care
• “Timeliness of Obtaining Surgical Clearance Documentation”
Mankato Surgery Center
• “Verifying Cleaning Processes for Reusable Biopsy Valves”
Maryland Endoscopy Center