"Seven Is the New Ten" - Comprehensive Quality Improvement Project to Adopt Restrictive Transfusion Strategies in a Community Hospital

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5574-5574
Author(s):  
Rahul Singh ◽  
Charin Hanlon
Keyword(s):  
Quality Improvement ◽  
Blood Loss ◽  
Conflicts Of Interest ◽  
Acute Blood Loss ◽  
Improvement Project ◽  
Chronic Anemia ◽  
Restrictive Transfusion ◽  
Pdsa Cycle ◽  
Pre Treatment ◽  
Order Set

Abstract Introduction: An estimated 13,785,000 units of packed red blood cells (PRBC) were transfused in the US in 2011 of which an estimated 57.9% were found to be from the medical service. Risks of blood transfusion include infections and transfusion reactions. In 2012, the American Association of Blood Banks released new guidelines for PRBC transfusion in hospitalized, hemodynamically stable patients. These guidelines set a threshold Hb of ≤7 g/dL in critically-ill patients, and a Hb ≤8 g/dL for surgical patients, for patients with pre-existing cardiovascular disease, or for patients with symptoms (tachycardia, chest pain or hypotension not corrected by crystalloids). Methods: An IRB-approved retrospective study of inpatient PRBC transfusions at New Hanover Regional Medical Center in Wilmington, NC was conducted in 2013. The average pre-treatment Hb was noted to be 7.42 ± 0.92 (p=0.0009) and average number of units transfused were 1.78 ± 0.58 (p=0.1133). The average number of units transfused were =1.5, and 31% of the time 1 unit was given. This data prompted a quality improvement initiative to improve in hospital transfusion strategies. The PDSA cycle included the following interventions: Hospital administration created a "Transfusion Safety Officer." A transfusion committee championed by the Blood Bank Director was formed. In addition, a series of hospital wide didactics centered on restrictive transfusion practices were held, targeting nursing and physicians of all disciplines. A public relations campaign was launched by the hospital involving posters, newsletters, bulletins, and emails centered around slogans "7 is the new 10" and "1 is better than 2." Four months after this, a new computerized physician order set was created by the Transfusion Committee and instituted in September 2014. The order set specifically separated out chronic anemia from acute blood loss anemia. Under the chronic anemia tab, practitioners can select the reason for PRBC transfusion based off of AABB guidelines, but are restricted to only transfusing 1 unit of PRBC at a time. Finally a new "My Report" has been built within EPIC EMR to allow a physician to see their transfusion average Hb and number of units ordered. An IRB-exempt review of PRBC transfusions after the quality improvement impact and post CPOE go-live date was conducted. A total of 493 PRBC transfusions in non-acute blood loss patients were given between 9/11/14-11/1/14. The average pre-treatment Hb 7.0 of which 59% of the time 1 unit was PRBC was ordered. Discussion: A comprehensive, interdisciplinary QI project can successfully reduce unnecessary PRBC transfusions. By applying the PDSA cycle and harnessing the power of the EMR, we can improve the rapidity with which physicians adopt new evidence based guidelines. The success of a hospital-wide QI project of this magnitude hinges on a motivated project management team able to engage all necessary stake-holders, to include the hospital C-Suite. Disclosures No relevant conflicts of interest to declare.

scholarly journals Standardizing Postpartum Discharge Instructions With an Educational Video: A Quality Improvement Project

Iproceedings ◽  
10.2196/15245 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e15245
Author(s):  
Jennifer Hoffman ◽  
Lori Burke ◽  
Cheryl Kay ◽  
Rachel Hlavaty ◽  
Jennifer Thompson-Wood ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Education ◽  
Blood Loss ◽  
Warning Signs ◽  
Quality Improvement Project ◽  
Educational Video ◽  
Acute Blood Loss ◽  
Improvement Project ◽  
Survey Responses ◽  
Discharge Education

Background The World Health Organization (WHO) estimates that, in the United States, 1200 women annually experience perinatal events that prove fatal and 60,000 suffer complications that are near-fatal. Postpartum morbidity and mortality may be decreased by explicit patient education. At our institution, the maternal discharge education process was varied among providers. Of the available literature, most focus on maternal knowledge of pediatric concerns with a limited amount of studies looking at maternal postpartum health. Objective The objective of this quality improvement project is to standardize postpartum education with the use of a postpartum education video available on a bedside tablet in order to improve maternal perception and knowledge of postpartum warning signs. Methods This prospective cohort study was designed using a patient survey which was administered to evaluate the effectiveness of the maternal discharge education procedures in our institution. The baseline results were reviewed by a team of physicians and nurses. A 10-question survey was provided to patients following the birth of their first baby about maternal warning signs and complications after discharge from the hospital. A standardized discharge education video was created using information from ACOG and AWHONN. The video was made accessible on bedside tablet devices. Patients were able to indicate understanding or request clarification on the devices after review of the materials, and this was communicated from the tablets to the electronic health record. All postpartum nurses were trained on the video content and how to operate the tablets. Survey responses were collected via bedside tablets following implementation of the video and were compared with the baseline results. Educational information was available to patients after discharge from the hospital via a patient portal. Results Twenty-nine women were surveyed prior to implementation of the standardized educational video available on bedside tablets. After implementation, 50 women were surveyed. Comparison of the survey responses showed there was an increase in patient-reported knowledge and understanding in all 10 questions on the survey. Of those, 4 areas were statistically significant with P values <.05: when to call 911 (82.8% before and 98% after), when to call your doctor (75.9% before and 98.0% after), heavy vaginal bleeding (62.1% before and 87.8% after), and symptoms of acute blood loss (51.7% before and 83.7% after). Conclusions The implementation of a postpartum education video available to patients on bedside tablets improved and standardized workflow for routine postpartum care and discharge processes. Survey questions regarding patient knowledge and perception of when to call 911, when to call your doctor, heavy bleeding, and signs of acute blood loss were all noted to be statistically significant. The improved perception of postpartum warning signs after the educational video appears to be beneficial in patient education at this high volume OB institution. The establishment of this platform for education became a model for education in other hospital units using bedside tablets. The use of a multidisciplinary team to review, revise, and standardize the postpartum education program at our institution was well received and supported by nurses, providers, and ultimately patients.

scholarly journals Quality improvement primer part 2: executing a quality improvement project in the emergency department

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 532-538 ◽  
Author(s):  
Lucas B. Chartier ◽  
Antonia S. Stang ◽  
Samuel Vaillancourt ◽  
Amy H. Y. Cheng
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Quality Improvement ◽  
Improvement Project ◽  
Emergency Department Setting ◽  
Pdsa Cycle ◽  
Time To Antibiotics ◽  
Final Article

ABSTRACTThe topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement. We will review what makes a good aim statement, the various categories of measures that can be tracked during a QI project, and the relative merits and challenges of potential change concepts and ideas. We will also present the Model for Improvement’s rapid-cycle change methodology, the Plan-Do-Study-Act (PDSA) cycle. The final article in this series will focus on the evaluation and sustainability of QI projects.

scholarly journals ‘CPR for Feet’ care bundle to improve foot assessment in inpatient diabetes

2018 ◽  
Vol 7 (3) ◽  
pp. e000196 ◽  
Author(s):  
Rhea O’Regan ◽  
Ross MacDonald ◽  
James G Boyle ◽  
Katherine A Hughes ◽  
Joyce McKenzie
Keyword(s):  
Quality Improvement ◽  
Nursing Staff ◽  
Quality Improvement Project ◽  
Care Bundle ◽  
Staff Education ◽  
Pressure Relief ◽  
Improvement Project ◽  
The Third ◽  
Inpatient Diabetes ◽  
Pdsa Cycle

AimsThe Scottish Inpatient Diabetes Foot Audit conducted in 2013 revealed that 57% of inpatients had not had their feet checked on admission, 60% of those at risk did not have pressure relief in place and 2.4% developed a new foot lesion. In response, the Scottish Diabetes Foot Action Group launched the ‘CPR for Feet’ campaign. The aim of this project was to raise awareness of the ‘Check, Protect and Refer’ (CPR) campaign as well as improve the assessment and management of inpatients with diabetes.MethodsA quality improvement project underpinned by Plan-Do-Study-Act (PDSA) methodology was undertaken. The first and second cycles focused on staff education and the implementation of a ‘CPR for Feet’ assessment checklist using campaign guidelines, training manuals and modules. The third and fourth cycles focused on staff feedback and the implementation of a ‘CPR for Feet’ care bundle.ResultsBaseline measurements revealed 28% of patients had evidence of foot assessment. Medical and nursing staff reported to be largely unaware of the ‘CPR for Feet’ campaign (13%). Fifty-two per cent of inpatients with diabetes had their feet assessed and managed correctly following the second PDSA cycle. After completion of the third and fourth PDSA this number improved further to 72% and all staff reported to be aware of the campaign.ConclusionsThe introduction of a ‘CPR for Feet’ care bundle improved the assessment of inpatients with diabetes.

scholarly journals Implementing the Patient Health Questionnaire Modified for Adolescents to improve screening for depression among adolescents in a Federally Qualified Health Centre

2020 ◽  
Vol 9 (4) ◽  
pp. e000751
Author(s):  
Mohamed Mansour ◽  
Dharshana Krishnaprasadh ◽  
Janice Lichtenberger ◽  
Jonathan Teitelbaum
Keyword(s):  
Quality Improvement ◽  
Adolescent Depression ◽  
Quality Improvement Project ◽  
Patient Health Questionnaire ◽  
Depression Symptoms ◽  
Health Questionnaire ◽  
Screening Rate ◽  
Improvement Project ◽  
Pdsa Cycle ◽  
Patient Health

BackgroundDepression, which is a serious medical illness, is prevalent worldwide and it negatively impacts the adolescent lifestyle. Adolescent depression is associated with adverse emotional and functional outcomes and suboptimal physical health. Over the last decade, it has been found that approximately 9% of teenagers meet the criteria for depression at any given time, and one in five teenagers have a history of depression during adolescence. Ninety per cent of paediatricians believe that recognition of child and adolescent depression is their responsibility; however, it has been reported that 46% lacked confidence that they could recognise depression.MethodsIn this study, adolescents between 12 and 17 years of age were screened during their well-child visits using the Patient Health Questionnaire Modified for Adolescents. A score of 10 or higher warrants a referral to a social worker and psychiatrist. The goals of this quality improvement project were to implement a standardised questionnaire and to improve the screening, diagnosis and treatment of depression in children from 12 to 17 years of age.ResultsIt was found that the adolescent depression screening rate significantly improved within 6 months of implementing this quality improvement project. The screening rate improved to 50% by mid-cycle (Plan-Do-Study-Act (PDSA) cycle 3) and up to 70% at the end of the 6-month period (PDSA cycle 5). Improvement was noted among all providers, across all age groups, and in both male and female patients by the end of the study period.ConclusionStandardised screening tests with a scoring system help providers to identify and monitor depression symptoms using a common language, especially in the outpatient clinical setting where the patient may be seen by different providers.

Improving time to initiation of bone modifying agents in patients with newly diagnosed multiple myeloma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6528-6528
Author(s):  
Nathaniel Rosko ◽  
Sarah Lee ◽  
Christy Joy Samaras ◽  
Alex V. Mejia ◽  
Faiz Anwer ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Quality Improvement ◽  
Cleveland Clinic ◽  
Institutional Care ◽  
Baseline Data ◽  
Physician Education ◽  
Newly Diagnosed ◽  
Improvement Project ◽  
Pdsa Cycle ◽  
Time To Initiation

6528 Background: Current ASCO and IMWG guidelines recommend that all patients (pts) on active anti-myeloma therapy receive concurrent supportive care treatment with a bone modifying agent (BMA) to decrease the risk of skeletal related events (SRE). Unfortunately, recent data shows only 51% of Medicare pts with myeloma received a BMA within 90 days of first chemotherapy. We implemented a quality improvement project to identify the average time to BMA initiation at all Cleveland Clinic affiliated sites, with the primary goal to improve time to initiation of BMA in newly diagnosed multiple myeloma (NDMM) pts by 4 weeks at Cleveland Clinic Main Campus (MC). Methods: Barriers with BMA initiation were identified using quality improvement tools developed at the ASCO Quality Training Program. The first PDSA cycle was implemented between September 2018 – January 2019 with an emphasis on education. This included review of updated guidelines, literature review of risks and toxicities associated with BMAs, and strategies for choosing BMA based on pt factors. Baseline data on time to start BMA and data to evaluate impact of PDSA intervention was completed via chart review. Results: 161 NDMM pts were evaluated between 2015 to 2018 at all sites. The average time difference between the start of anti-myeloma therapy and the start date of a BMA in NDMM pts was 10.5 weeks. Subset analysis based on whether pts were treated at MC vs affiliate sites was 10.6 weeks vs 9.1 weeks, respectively. During the first PDSA cycle, 14 NDMM pts were treated at MC. 86% (12/14) pts were treated with a BMA. The average time between cycle 1 day 1 of first line treatment and first dose BMA was 4.3 weeks (range 4-12 weeks). Conclusions: With increased physician education and awareness of internal baseline data, we achieved our initial goal and observed a significant improvement in time to initiation of BMA from 10.5 weeks to 4.3 weeks. Obstacles regarding effective communication with patients on the benefit of BMAs as well as need for dental clearance were barriers identified early on. We plan to incorporate BMA guidelines in our institutional care path with the goal to decrease time to initiation at all affiliated practices. Further mechanisms to ensure reinforcement of BMA initiation in NDMM patients is warranted to maintain therapeutic benefit.

scholarly journals Trainee-Led Quality Improvement Project to Improve Fertility Preservation Counseling for Patients With Cancer

2021 ◽  
pp. OP.21.00479
Author(s):  
Laura A. Sena ◽  
Ramy Sedhom ◽  
Susan Scott ◽  
Amanda Kagan ◽  
Andrew H. Marple ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Reproductive Age ◽  
Cancer Center ◽  
Patient Centered ◽  
Improvement Project ◽  
Quality Cancer Care ◽  
Pdsa Cycle ◽  
Order Set

PURPOSE: Oncofertility counseling regarding the reproductive risks associated with cancer therapy is essential for quality cancer care. We aimed to increase the rate of oncofertility counseling for patients of reproductive age (18-40 years) with cancer who were initiating systemic therapy at the Johns Hopkins Cancer Center from a baseline rate of 37% (25 of 68, June 2019-January 2020) to 70% by February 2021. METHODS: We formed an interprofessional, multidisciplinary team as part of the ASCO Quality Training Program. We obtained data from the electronic medical record and verified data with patients by phone. We surveyed patients, oncologists, and fertility specialists to identify barriers. After considering a prioritization matrix, we implemented Plan-Do-Study-Act (PDSA) cycles. RESULTS: We identified the following improvement opportunities: (1) oncologist self-reported lack of knowledge about counseling and local fertility preservation options and (2) lack of a standardized referral mechanism to fertility services. During the first PDSA cycle (February 2020-August 2020, disrupted by COVID-19), we introduced the initiative to increase oncofertility counseling at faculty meetings. From September 2020 to November 2020, we implemented a second PDSA cycle: (1) educating and presenting the initiative at Oncology Grand Rounds, (2) distributing informative pamphlets to oncologists and patients, and (3) implementing an electronic medical record order set. In the third PDSA cycle (December 2020-February 2021), we redesigned the order set to add information (eg, contact information for fertility coordinator) to the patient after-visit summary. Postimplementation (September 2020-February 2021), counseling rates increased from 37% to 81% (38 of 47). CONCLUSION: We demonstrate how a trainee-led, patient-centered initiative improved oncofertility care. Ongoing work focuses on ensuring sustainability and assessing the quality of counseling.

Using Lean methodology to improve the time to antibiotics in oncology patients on chemotherapy who present to the ED with neutropenic fever.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 31-31
Author(s):  
Brian J. Byrne ◽  
Frederick Bailey ◽  
Pat Montanaro ◽  
Patricia Anne DeFusco
Keyword(s):  
Quality Improvement ◽  
Substantial Improvement ◽  
Neutropenic Fever ◽  
Medical Emergency ◽  
Antibiotic Administration ◽  
Improvement Project ◽  
The Third ◽  
Pdsa Cycle ◽  
Time To Antibiotics ◽  
American Society

31 Background: Neutropenic fever is a medical emergency. Delays in treatment can lead to increase in morbidity, mortality, and increase length of stay. The American Society of Clinical Oncology currently recommends that antibiotics be prescribed within 60 minutes of triage. Literature review shows through a multidisciplinary effort involving the ED, lab, oncology, and pharmacy significant improvement in time to antibiotics can be achieved. Since many patients with neutropenic fever present with sepsis, these guidelines also will need to be followed. Methods: Three PDSA cycles were conducted. The first involved education of the ED staff on the importance of treating neutropenic fever and using the correct antibiotic. The second PDSA cycle involved the laboratory and the calling of critical white counts and low neutrophil counts. The third PDSA involves patient education on the importance of temperature monitoring and reporting they are on chemotherapy to ED staff. Results: Baseline data show only 33% of patients receive the correct antibiotic and the average time to administration is 3 hours and 41 minutes. Results of the quality improvement project show a substantial improvement in time to antibiotic administration to 1 hour 58 minutes and an increase in the percentage of patients who receive the correct antibiotic. The time from the specimen received in the lab until critical called also improved from 1 hour 14 minutes to 18.5 minutes. Conclusions: This quality improvement led to a significant improvement in time to correct antibiotics, but several additional steps need to be taken to meet ASCO guidelines. [Table: see text]

scholarly journals P065: Development and implementation of a postpartum hypertension recognition and management protocol for use in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S80-S80
Author(s):  
T. Hawkins ◽  
S. K. Dowling ◽  
D. Wang ◽  
A. Mahajan ◽  
A. Mageau ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Quality Improvement ◽  
Clinical Care ◽  
Population Characteristics ◽  
Improvement Project ◽  
Protocol Implementation ◽  
Management Protocol ◽  
Order Set

Introduction: Hypertensive disorders of pregnancy (HDP), including preeclampsia, can develop or worsen in the early postpartum period, often following discharge from hospital, resulting in severe preventable maternal morbidity and mortality. Due to a lack of routine early out-patient follow-up, many women with postpartum HDP present to the emergency department (ED) with severe hypertension or symptoms of preeclampsia (e.g., headache). In the ED, postpartum HDP can be difficult for clinicians to recognize (due to vague presenting symptom) and manage (due to lower blood pressure targets and concern of medication safety). ED clinicians recognized a need for timely recognition and effective treatments for postpartum HDP in the ED to improve maternal outcomes. As such, as part of a multi-step quality improvement initiative, an interdisciplinary team developed and implemented a postpartum HDP management protocol (consisting of nursing and physician protocols and an electronic order set embedded in the electronic medical record). The aims of this specific project were to assess: 1) the use of this clinical management protocol in the ED; and 2) its impacts on clinical care. Methods: This quality improvement project used electronic medical records to identify: 1) ED visits for postpartum HDP for postpartum women ages 20-50; 2) utilization of the postpartum HDP order set; and 3) clinical care outcomes (consultation and admission). Patient population characteristics and clinical care measures were summarized with descriptive statistics and compared using a before and after design. Changes in the utilization of the protocol were assessed using run charts. Results: 540 women with postpartum HDP were seen in the four Calgary EDs in the 16-month period following protocol implementation compared with 335 women in the preceding 12 months. The protocol was used in 46% of these 540 women, and increased over the 16 month follow-up period. We found an increase in the frequency of consultation of specialists (47% to 52%) and admissions (26% to 29%) amongst these women after protocol implementation. Conclusion: This initial assessment demonstrated good uptake of a postpartum HDP management protocol including referral for consultation and admission to hospital for blood pressure management. Future steps include evaluation of the impacts of this management protocol on important patient outcomes.

scholarly journals A quality improvement project to increase patient feedback in the psychotherapy department, Tavistock Clinic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S170-S171
Author(s):  
Avgoustina Almyroudi ◽  
Alan Baban ◽  
Sukhjit Sidhu
Keyword(s):  
Quality Improvement ◽  
Online Survey ◽  
Response Rate ◽  
Feedback System ◽  
Response Rates ◽  
Improvement Project ◽  
Complex Needs ◽  
The Core ◽  
Patient Feedback ◽  
Pdsa Cycle

AimsA rigorous and systematic patient feedback system is important for identifying gaps, improving the quality of care and encouraging patient involvement in service delivery. In the Adult Complex Needs Service of the Tavistock Clinic, a tertiary psychotherapy centre, only 5% of patients have provided feedback when requested. This Quality Improvement (QI) project aimed at improving the return rates of the Experience of Service Questionnaire (ESQ) and the CORE Outcome Measure by 10% within a year.MethodThe QI methodology was used to help identify factors contributing to the low response rate, including views amongst stuff about how such feedback, and the method of its delivery, might affect a psychoanalytically-informed treatment. Previously these forms were posted or handed out in person. In the first Plan-Do-Study-Act (PDSA) cycle, the method of distribution was changed by sending out the questionnaires to patients electronically, using an online survey platform. In the second PDSA cycle, the CORE-34 questionnaire was replaced with a shorter version, the CORE-10. This was in order to test our hypothesis that a shorter questionnaire would result in an increase in the response rates.ResultIn the first cycle of change, 197 patients were emailed for both the CORE-34 and ESQ and a total return rate of 31% was achieved. This signified an increase of 26% in the response rate. Overall more ESQ forms were completed (35% uptake) compared to CORE-34 forms (28% uptake). In the second cycle 199 patients were emailed with the CORE-10 and ESQ forms. The response rate was 21% and 18% respectively. Although the response rates decreased slightly in the second PDSA cycle the results indicated that this method of distribution was capturing a greater range of patients who had not previously provided the service with this sort of feedback.ConclusionSending out the outcome measures electronically and adopting shorter versions of the CORE questionnaire increased the feedback response rate significantly, and provided the service with useful data as to patients' experience of their treatment journey here.

A trainee-led quality improvement project to improve fertility preservation counseling and access to fertility preservation services for persons with cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 237-237
Author(s):  
Arjun Gupta ◽  
Laura Sena ◽  
Ramy Sedhom ◽  
Susan Combs Scott ◽  
Amanda Brooks Kagan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Fertility Preservation ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Systemic Therapy ◽  
Reproductive Age ◽  
Reproductive Endocrinology ◽  
Care Services ◽  
Pdsa Cycle ◽  
Order Set

237 Background: For patients of reproductive age with cancer, counseling regarding reproductive risks associated with systemic therapy and facilitating access to fertility services are essential to quality care. We conducted a quality improvement study to improve rates of fertility preservation counseling at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center (SKCCC) in Baltimore, MD. Methods: We formed a multidisciplinary team as part of the ASCO Quality Training Program. We aimed to increase the rate of fertility preservation counseling for patients of reproductive age (18-40 years) with newly diagnosed cancer who were initiating systemic therapy from a baseline (June 2019- January 2020) of 36.7% (25/ 68) to 70.0% by February, 2021. Data sources included the electronic medical record and direct verification with patients by phone. We surveyed patients, oncologists, and experts in reproductive endocrinology and urology to identify barriers to optimal care. After considering a prioritization matrix, we implemented Plan-Do-Study-Act (PDSA) cycles. Results: We identified the following improvement opportunities: (1) oncologist under confidence about counseling, (2) oncologist lack of knowledge about local fertility preservation options/ processes, and (3) lack of a standardized referral mechanism to reproductive endocrinology/ urology. The first PDSA cycle was disrupted due to COVID-19; from February 2020-August 2020, we introduced the initiative at oncology disease site meetings (e.g., leukemia). In September 2020, we implemented a second PDSA cycle. Our interventions included (1) presenting the baseline data and fellow-led initiative at Oncology Grand Rounds (attended by 150 staff members), (2) creating and distributing paper and electronic informative pamphlets to oncologists and patients, and (3) implementing an electronic medical record order set. This order set included instructions for providers and patients, necessary laboratory studies, and a referral to reproductive endocrinology or orders for cryopreservation of sperm. It also added the following to a patient’s after visit summary: contact information for a dedicated fertility coordinator, estimated costs of services, and financial assistance programs. Post-implementation (September 2020- February 2021), the percentage of patients who reported receiving fertility preservation counseling increased from 36.7% to 80.9% (38/ 47). A sustained shift in the process was apparent on a control chart. Conclusions: Despite disruptions caused by the COVID-19 pandemic, we demonstrate how a trainee-led, patient-centered initiative improved fertility care services for people with cancer. Ongoing work focuses on ensuring sustainability of change, assessing the quality of counseling, and evaluating the impact on utilization of fertility care services.

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