1. Decreasing turnaround time in getting test results to patients. Performance Improvement Leadership Develop Program University of Missouri – Columbia 2/18/2011

2. Team Members Jacqueline Ruplinger, MD (Blue Team GM) Cynthia Twenter, LPN (Blue Team GM) Rosie Powell, PSR (Blue Team GM) Anne Fitzsimmons, MD (Sponsor) Tim Hogan, RRT, PhD (Advisor) Carol Nierling, MS, RN (Advisor)

3. Focus Area Patients do not get their test results within the 5 day recommendation put forth by University Physicians Getting test results to patients is done in a variety of ways and requires a lot of provider and staff time and resources

4. Aim Statement Improve the notification process by which patients on blue team receive their test results. We want to decrease the time from the result getting to the provider’s inbox to the patient from >5days to <5days by 90% within 60days of implementation of Healthe and other outlined standardized/streamlined processes.

5. Relationship to Strategic Goals of the Institution & our Department UP directive -the patient should receive test results within 5d 1-27-10 FM Departmental Policy - 4-7-10 Ordering provider will review all results both normal and abnormal Normal and abnormal results will be communicated to the patient Approved methods of communication were outlined: clinic visit, PC generated test result letter, lab card with electronic documentation that it was done and sent, phone call-either by provider or nurse* (guidelines as to when a nurse should call outlined)

6. Project Timeline

7. Process Flow Chart for a Provider Provider steps to generate a lab letter to a patient 21 clicks 1 min 43 secs With Healthe 6 clicks 40 secs With Healthe 6 clicks 40 secs

8. Process Flowchart for a Nurse Nurse sends “nl” pap letter for provider 43 clicks 4 min Standardizing “nl” pap letters saves steps

9. Process Flow Chart for a PSR Process for mailing a letter 25 clicks 4-5 min Utilizing see-through envelopes saves steps and eliminates errors

10. Fishbone Diagram

11. Stakeholders Patients Providers-residents and attending physicians Staff-phone nurses, PSRs & floor nurses Care coordinator-Joan Asbee Lab/radiology Cerner staff

12. Baseline data

13. Baseline Data cont. One providers experience to endorse and make lab letters on 14 patients -37min to do 14 letters -238 clicks (Note this does not include the time it takes for the nurse or PSR to process the letter and mail the letter, this would add an additional 63 min)

14. Interventions Considered Electronic Approach-Healthe Phone approach-standardize times when providers would ask the nurse to call patients* Standardization of workflow processes-letters, envelopes Request input from patients how they would like to hear about their test results * already outlined by our department April 2010

15. Measurements Time it took for patients to get test results Time it takes to process letters to patients Time for the letter to get through the mail Patients perception pre and post intervention

16. Outcomes to Date

17. Patient Feedback N=36

18. Workflow Change

19. Anticipated ROI/ Benefits Realized Using the electronic approach to communicate test results to pts -541 physician hrs/yr in time saved -867 staff hours/yr saved -$5,200 saved in postage Workflow processes streamlined Secondary benefits of Healthe Eliminated wrong letter to wrong pt All increases pt, staff and provider satisfaction

20. Lessons Learned It took much longer to get Healthe going Pts did not register as quickly as we anticipated When the “create” button lights up in “results to endorse” that does not mean the pt has registered FU after an intervention is very important Improvement work takes people with different backgrounds and skill sets There are a lot of tools available and IT’s FUN!

21. Future Steps Continue the momentum in enrolling pts Focus on the FU surveys before rolling out to the rest of Green Meadows Share our findings/experiences at team mtgs Present our findings at a Colwill seminar Cont. to look at all the test result processes Integrate PDSA in our daily routine-meet monthly

22. Summary By implementation of an electronic way of communicating results to patients greatly reduced turnaround time and did not take more provider or staff time Standardizing how results get to patients and creating form letters & utilizing see-through envelopes also decreased waiting times

23. Summary Service People Finance Quality Growth Community

24. Questions?