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.

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.

scholarly journals Use of Electronic Medical Record Data for Quality Improvement in Schizophrenia Treatment

2004 ◽  
Vol 11 (5) ◽  
pp. 351-357 ◽  
Author(s):  
Richard R. Owen ◽  
Carol R. Thrush ◽  
Dale Cannon ◽  
Kevin L. Sloan ◽  
Geoff Curran ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Medical Record Data ◽  
Electronic Medical Record Data ◽  
Record Data

scholarly journals QLIF-14. QUALITY IMPROVEMENT AND PRACTICE BASED RESEARCH IN NEURO-ONCOLOGY USING THE ELECTRONIC MEDICAL RECORD

2016 ◽  
Vol 18 (suppl_6) ◽  
pp. vi158-vi159
Author(s):  
Ryan Merrell ◽  
Nina Martinez ◽  
Susan Stasinos ◽  
James Muresan ◽  
Shaun Walters ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Practice Based Research

Referral trends for reproductive-age patients with breast cancer to a reproductive endocrinology clinic for fertility preservation counseling between 2004 and 2012.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 129-129
Author(s):  
Jonathan David Kort ◽  
Kira Seiger ◽  
Solomon Henry ◽  
Lynn Westphal
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Reproductive Age ◽  
Oocyte Cryopreservation ◽  
Cancer Center ◽  
Research Database ◽  
Breast Cancer Patients ◽  
Reproductive Endocrinology ◽  
Patients Âgés

129 Background: As of October 2012, both embryo and oocyte cryopreservation are considered non-experimental fertility preservation (FP) options for cancer patients facing potentially gonadotoxic therapy. This study aims to assess the historical referral frequency of reproductive aged breast cancer patients from a major cancer center to an associated reproductive endocrinology and infertility (REI) clinic for counseling regarding FP and also assess how frequently these patients underwent FP after referral. Methods: Using the Stanford Cancer Center Research Database in conjunction with our EMR, a query was made for patients of reproductive age (13-45) who were seen at the Stanford Cancer Center for a new breast cancer diagnosis between 2004 and 2012. These patients’ records were then searched for referral encounters in the REI department. Those who were seen by REI were assessed for having undergone FP via embryo or oocyte cryopreservation prior to starting chemotherapy. Results: 420 women, ages 20 to 45, were seen at our cancer center for a new diagnosis of breast cancer between 2004 and 2012. Sixty (14.3%) of these patients, ages 20 to 42 at diagnosis, were referred to the REI department for FP counseling. Patients who were referred for FP counseling were 5.1 years younger at diagnosis than those who were not (p<.005). Of those referred, 33.3% underwent FP with embryo (77%) or oocyte cryopreservation (23%) under an experimental protocol. Among breast cancer patients ≤35 years old, 35% were referred to our REI department for FP counseling and 53.5% of those referred underwent FP. Conclusions: Despite advances in FP technology, the majority of reproductive aged breast cancer patients are still not referred for FP counseling by a reproductive endocrinologist. This trend was also seen among patients younger than 35—a subgroup who is more likely to undergo and benefit most from FP. This study does not reflect patients who decline this opportunity or seek FP elsewhere, however additional study and outreach is needed to improve referral rates, which are now a measure of the Quality Oncology Practice Initiative (QOPI).

Abstract P830: Using a Nurse Tasklist in an Electronic Medical Record to Achieve Compliance With Documentation of Post Procedure Assessments

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Leigh Allen ◽  
Katie Scott ◽  
Lisa Votti ◽  
Nicole Vella ◽  
Tracy Robinson ◽  
...  
Keyword(s):  
Patient Safety ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Endovascular Procedures ◽  
Compliance Rate ◽  
Medication Administration ◽  
Monitoring Period ◽  
Post Procedure ◽  
New Process ◽  
Order Set

Background: For stroke centers performing endovascular procedures, ensuring documentation of post procedure assessments - site and pulse - is not only important for patient safety but also for program certification. Not being able to demonstrate the appropriate documentation during certification site visits can lead to survey findings and action plans that must be created and managed. Use of tools in an EMR can assist the nurse with documentation compliance for these important assessments. Methods: The electronic medical record (EMR) build was mirrored after an already established process for post IV thrombolytic monitoring. When the thrombolytic order set is initiated and the IV thrombolytic medication is documented on the medication administration record, tasks “fire” to the nurse tasklist related to post thrombolytic monitoring for the 24 hour post IV monitoring period. The nurse can select the task on the tasklist and it takes the nurse to the appropriate place to document as well as at the appropriate time to document. Use of this process helped to drive compliance with post IV thrombolytic monitoring documentation. In order to achieve compliance for post procedure assessments documentation, this same process was requested by nursing. To achieve this, the EMR was designed to “fire” tasks to the nurse tasklist when the post thrombectomy order set is initiated and the time hemostasis is achieved is documented; these tasks cover the post thrombectomy monitoring for the required 24 hours. Part of these tasks include post procedure assessments. Results: From May 2019 to October 2019 the average monthly compliance for post procedure assessments was 77.6%. In November 2019, the appropriate tasking function was implemented in the EMR and education related to the new process was provided. From December 2019 to May 2020 average monthly compliance has been 91.1% with a monthly compliance rate greater than 90% since February 2020. Conclusions: Use of the nurse tasklist in an electronic medical can assist the nurse with documentation of post procedure assessments and achieve documentation compliance.

scholarly journals Utilization of an Electronic Medical Record–integrated Dashboard Improves Identification and Treatment of Anemia and Iron Deficiency in Pediatric Inflammatory Bowel Disease

2020 ◽  
Author(s):  
Jessica Breton ◽  
Char M Witmer ◽  
Yuchen Zhang ◽  
Maura Downing ◽  
Jamie Stevenson ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Quality Improvement ◽  
Iron Deficiency ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Bowel Disease ◽  
Care Pathway ◽  
Evidence Based ◽  
Inflammatory Bowel ◽  
Evidence Based Care

Abstract Background Iron deficiency (ID) and anemia are one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD), usually complicating the course both in ulcerative colitis and Crohn’s disease. Despite their high prevalence and significant impact on patients, this particular aspect is still underestimated by clinicians. Although guidelines have been recently published to address this problem, these recommendations do not address pediatric specific concerns and do not provide guidance as to how implement these guidelines in clinical practice. The aims of this quality improvement (QI) initiative were to improve the rates of detection and treatment of anemia in children with IBD. Methods After the creation of a multidisciplinary team of skateholders in IBD and anemia, we launched a multifaceted QI strategy that included the development of a pediatric evidence-based care pathway, utilization of an electronic medical record (EMR)-integrated dashboard to track patients, and generation of an automated provider-based monthly report. Data were collected and graphed into statistical process control charts. Results These key strategies resulted in improved rates of ID screening from 31.7% to 63.6%, in increased treatment rates from 38.2% to 49.9%, and in decreased prevalence of anemia from 35.8% to 29.7%, which was reflected by a greater decline in patients with quiescent disease. Conclusions Quality improvement strategies incorporating the creation of a pediatric evidence-based care pathway with an EMR-supported electronic dashboard were the foundation of a successful intervention in the management of ID and anemia in pediatric IBD. Our positive results demonstrate the potential of QI initiatives using automated technology to assist clinicians in their commitment to provide evidence-based IBD care and enhance patient outcomes.

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