Berks County Medical Society Medical Record Fall 2017 - 21

um mer Research Projects
Quality Improvement Project in the Family
Health Care Center at the Reading Hospital
by Paige Naseef1; William Lovett, MD2; Syed Jafry, MD (PGY-3)2;
Justin Rutherford, DO (PGY-2)2; Annmarie Schuler, LPN2; Joycelean Jost, RN2.
Department of Biology, Albright College, Reading, Pennsylvania
Department of Family Medicine, Reading Hospital, Reading, Pennsylvania
1

2

Background: The Family Health Care Center (FHCC) is an
ambulatory care clinic that is part of the Family Medicine Residency
program at the Reading Hospital. Every summer, the Reading
Hospital invites several undergraduate and medical students to
participate in a six-week summer internship to work with physicians
on various clinical projects.
Local Problem: The summer internship time frame provided an
opportunity to begin a quality improvement project focused on
improving office efficiency and communication.
Methods: A team consisting of an attending physician, two
resident physicians, two nurses, and the summer intern met to
determine areas of weakness and barriers to efficient workflow in
the clinic. Using the identified areas of improvement, the team
chose four interventions to trial. Two surveys were sent out to the
residents and faculty - one before the project interventions were
implemented, and one during the last week of the internship to
determine the efficacy of the interventions. The nurses and the
summer intern, who also acted as a medical scribe, were responsible
for disseminating the chosen interventions.
Interventions: The four interventions involved creating reference
boards, streamlining the existing dotphrase tool in EPIC (the
electronic medical record system used by the FHCC), improving
the huddle with nurses, and setting an agenda with nurses and
patients. The reference boards were located in each work station in
the clinic. They were organized with information that physicians
might need while seeing patients, such as billing and diagnosis
codes. A dotphrase dictionary was also created to streamline
documentation. Dotphrases are EPIC shortcuts that allow different
information from a patient's chart (e.g. recent lab work) to be
pulled into the note for that visit. Another intervention emphasized

the importance of physicians and nurses studying patients' charts
prior to an office session, then discussing that information in a
"huddle." Short paragraphs were posted on the reference boards
about how setting an agenda with nurses and patients, as well as
practicing active listening, could also improve efficiency.
Results: As this was a quality improvement project, there was no
collection of quantitative data or statistical analysis performed.
However, the results of the final survey were instead used to assess
the efficacy of the implemented interventions. The eleven responses
to the final survey were overwhelmingly positive, revealing that the
physicians utilized the interventions and became more aware of
their time management while in the clinic. Physicians also reported
that working with the scribe, while not a direct intervention,
improved office flow and decreased after-hour documentation.
Conclusions: This project helped to open a line of dialogue about
ways to improve efficiency in the FHCC. Moving forward, the line
of communication will remain open and incremental improvements
will be made to the interventions in place, such as expanding the
dotphrase dictionary.

Paige Naseef is a senior at Albright College,
pursuing a B.S. in Biology/Pre-Medicine with a
minor in Classical Studies. Paige has served as
President of Beta Beta Beta - Biology Honors
Society - and has worked at The Reading Hospital
as Scribe Educator and Coordinator for the 2017
class of Scribe Externs.
continued on next page >

FALL 2017

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Berks County Medical Society Medical Record Fall 2017

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