City of Hope leaders and staff aim to remove patients’ roadblocks to good care — even if these barriers take the shape of extra paper, forms and documents.
“We intend to examine our current processes, with an eye toward adding real value to the patient experience and reducing unnecessary, duplicative and onerous paperwork,” said Virginia Opipare, executive vice president and chief operating officer.
|Sharon Steingass explains changes in the collection of medical records. (Photo by p.cunningham)|
Staff recently came together through two Accelerating Care Excellence (ACE) rapid improvement events to address important issues related to forms and medical records, and they reported their achievements on Feb. 5.
Collecting medical records
In the past, new patients had to gather all their own medical records for their first visit with a City of Hope physician, which took a lot of time and effort. “Patients come to City of Hope to be taken care of, but we required them to do a significant amount of running around,” said Mickey McCabe, administrative manager in the Department of Surgery and team leader for the record collection project.
Not only was the process a burden on patients, but it also meant some records were not collected or available for the patient’s first doctor’s visit. As McCabe explained, new patients’ medical files used to be kept in New Patient Services until all records were collected — and only then were they distributed. When patients were unable to secure some information before their first visit, physicians or staff from New Patient Services often had to call various City of Hope departments to find records and get the information rushed to the clinic.
During the improvement event, City of Hope began providing new patients with a consent form giving staff permission to collect medical records from other providers. The improved process allows City of Hope staff to directly request the specific medical records. Also, staff now ensure all information, including diagnostic images and test results, are scanned into the patient’s electronic medical record the day before the patient’s first appointment to avoid delays on the day of the visit.
When team members surveyed physicians about their day’s cases at the end of the improvement event, they found that surgeons had most — if not all — of the information needed for most patients, reducing the need for rushed calls. The team will continue honing the process and eventually roll it out to other areas such as Medical Oncology and Radiation Oncology.
Lab test orders
Even though cancers are diverse and require different therapies, City of Hope had only one form for lab test orders, the Testing Service Requisition — and it packed all test options onto one sheet of paper. The result: inefficiency.
“The form was developed to serve multiple purposes, but as needs changed over time, the process of completion and routing has become slower, more complicated and more error prone,” said Douglas Stahl, Ph.D., vice president of clinical research operations and team leader for the lab test order team.
|Jody Seerup, left, Regina Buchanan and Venise Shazier perform a skit about the construction of lab test order forms. (Photo by p.cunningham)|
Cramped spacing and two attached carbon copies contributed to the clutter. Sometimes the carbon copies were barely legible or had stray marks that could be confused as orders, which required time-consuming verification. Additionally, paper copies sometimes got lost, he said.
According to Stahl, completing the lab test orders and routing them “previously involved an 89-step process using three-part paper forms that generate many different kinds of errors, including extra information when people write too hard and missing information when people don’t write hard enough.”
The team developed a separate form for hematology patients that included commonly ordered tests and removed inappropriate ones. They also eliminated all extra copies of the form. Stahl added, “Our most ambitious undertaking was to create a new electronic delivery system that uses a scanner at each scheduling station to create a digital image of the form.” The new, one-page form scans into the electronic medical record and is instantly available to all appropriate departments.
Opipare praised the process. “Our improvement events are about removing barriers so that our staff can focus on what they are best at, taking care of our patients. We’ve seen these events empower our staff to push improvements in their areas on their own initiative for everyone’s benefit.”
The next two events are scheduled for March 1-5. They will address revising lab test orders to suit each practice area and preparing patients before surgery.
For more information, employees may visit www.coh.org/ACE. Questions about ACE also may be addressed to Tricia Kassab, vice president of quality and patient safety, at email@example.com.