MethodThis project aims to implement the HCV birth cohort screening guidelines over a 9-month period in the primary care setting at the University of Kansas Health System General Internal Medicine Division. The project team measured the number of patients in the baby boomer population who received a one-time screen for HCV. An electronic medical record (EMR) intervention was implemented to identify baby boomers who did not have an HCV screening or diagnosis. Additionally, education was provided to all primary care providers in the clinic to increase awareness of the HCV birth cohort screening.ResultsThe quality improvement methods increased the percentage of baby boomers who obtained a one-time screening test for HCV from a baseline of 30% to a 55% screening rate during the nine-month project period.ConclusionIdentifying the HCV screening needs and creating a visual reminder in the EMR can be used to facilitate sustainable awareness and improvement of screening rates. The project team recognizes that continued work is required to close the HCV screening care gaps in the primary care setting.

For hospitals located in the United States, appropriate use of cardiac telemetry monitoring can be achieved resulting in cost savings to healthcare systems. Our institution has a limited number of telemetry beds, increasing the need for appropriate use of telemetry monitoring to minimise delays in patient care, reduce alarm fatigue, and decrease interruptions in patient care.This quality improvement project was conducted in a single academic medical centre in Kansas City, Kansas. The aim of the project was to reduce inappropriate cardiac telemetry monitoring on intermediate care units. Using the 2004 American Heart Association guidelines to guide appropriate telemetry utilisation, this project team sought to investigate the effects of two distinct interventions to reduce inappropriate telemetry monitoring, huddle intervention and mandatory order entry. Telemetry utilisation was followed prospectively for 2 years.During our initial intervention, we achieved a sharp decline in the number of patients on telemetry monitoring. However, over time the efficacy of the huddle intervention subsided, resulting in a need for a more sustained approach. By requiring physicians to input indication for telemetry monitoring, the second intervention increased adherence to practice guidelines and sustained reductions in inappropriate telemetry use.

Electronic health record patient portal usage has been associated with improvement in chronic disease parameters, patient functional status and patient satisfaction. Our institution’s patient portal is a secure, online health management tool that connects patients to portions of their electronic health record.Our quality improvement project aimed to increase patient portal enrolment significantly in our Internal Medicine resident patient panels.This study was conducted in a large, multisite health system in Kansas City, Kansas that serves a diverse patient population. Our clinic includes 65 resident patient panels. We followed a subset of 16 resident patient panels in this quality improvement project. A baseline audit showed that 35% of the 1628 patients in these panels were enrolled in the patient portal system. A standardised, nurse-initiated portal sign-up process following patient rooming was implemented. Initial results indicated a 9.6% increase in patient portal sign-up at the end of the first 4-week cycle. We then implemented educational sessions for our clinic nurses as well as attending physicians, and achieved a 15.1% increase from baseline to the end of the second 4-week cycle, resulting in 86 patient portal activations (p<0.01).Resident physicians worked with clinic nurse partners in two formats for this project. Nurses assigned to patient rooming for residents during the clinic sessions being studied (rooming nurses) initiated the portal sign-up process. Nurses assigned to partner with the resident for longitudinal patient care management, anchor nurses, worked with residents on items such as phone messages or portal messages. Semi-structured interviews of the four anchor nurses aligned with the 16 residents were conducted at the end of the study and revealed that nursing staff perceived increased patient portal activity to be associated with a decrease in nursing workload and an increase in patient engagement.

Discomfort in the hospitalised patient continues to be one of the healthcare system’s greatest challenges to positive patient outcomes. The patients’ ability to focus on healing is impaired by discomforts such as pain, nausea and anxiety. Alternative, non-pharmacological therapies have shown to be effective in reducing discomfort and managing pain, complementing analgesic agents and optimising pain therapy modalities. This multi-cycle project is aimed to assess the effect of alternative therapies on inpatient, progressive care patients who reported discomfort or little to no relief in discomfort from prescribed analgesics and adjuvant agents. In the first Plan Do Study Act (PDSA) cycle, patients who reported discomfort were offered aromatherapy or visual relaxation DVDs. In the second PDSA cycle, patients were offered a comfort menu that consisted of multiple alternative interventions such as aromatherapy, ice or heat and ambulation. During each cycle, participants completed a survey measuring comfort levels before and after patient-selected alternative intervention(s) were administered. In the first PDSA cycle, 88% of patients reported an increase in comfort level after the intervention, and 97% reported an interest in using alternative therapy again. In the second PDSA cycle, 47% reported increased comfort, and 89% indicated a willingness to try alternative therapies again for improvement of comfort level. Overall, the quality improvement project increased the level of comfort reported by hospitalised patients, creating a gateway to comfort with less emphasis on prescribed analgesic medications.

33 Background: With growing numbers of childhood cancer survivors (CCS), having systems for survivorship care coordination is imperative. While studies have compared the comfort and knowledge between primary care and oncology physicians in providing CCS care, few have analyzed primary and subspecialty care rates. Referral trends can be informative for institutions developing systems of care. Correlative measures with referral needs may help institutions prioritize process development for patients. Methods: Retrospective chart reviews were completed on 117 adult CCS from Survivorship Transition Clinic (STC) between 2014-2017. Upon arrival, STC patient self-reports were recorded regarding existing PCP status. Patients with PCPs were enrolled in survivorship consultation care, those without enrolled in survivorship and PCP care. Referrals were tracked by electronic medical record. Two oncology providers performed blinded independent reviews treatment summaries and scored treatments using Children’s Hospital of Philadelphia Intensity of Treatment Rating scale (ITR-3). If scores differed, discussion determined consensus. Final scores were matched with data on subspecialty referral patterns. Results: Of 117 patients, 65 (57%) needed both PCP and survivorship care while 50 (43%) had established PCPs. ITR3 scores were low intensity (1 or2) for 54 patients and high intensity (3 or 4) for 63 patients. The low intensity group had 157 total referrals (3 per patient) compared to 391 total referrals (6 per patient) in the high intensity group. The top 5 subspecialty referrals (by patients referred) were psychological services (46), dermatology (44), fertility (29), hematology / oncology / BMT (22), cardiology (20). Conclusions: Our care coordination trends suggest many CCS do not have established PCPs despite their complex care needs. Not surprisingly, higher intensity treatment correlates with higher subspecialty care needs. Psychological care remains the most prevalent need in our patient population. [Table: see text]