4 Accelerating hemoglobin (HbA1C) test results in follow-up diabetic clinics at a primary healthcare (PHC) center using the point-of- care HbA1c testing device

Abstract

Background Based on daily manual patient registry data, as of September 2018, we found that all follow-up patients with diabetes (100%) at Almasif Primary Care Center in Northern Riyadh had to wait an average of 3.5 days for their hemoglobin A1C (HbA1c) results in order for their physician to make any decisions on their treatment plan. One of the main quality dimensions is the improvement of the timeliness of healthcare, including reducing unnecessary waiting that might cause a harmful delay for patient and providers. Thus, creating a lean management process for diabetic patient work-up will lead to better care in terms of awareness, diagnosis, and treatment, and improve the quality of diabetic patient care in primary healthcare. The setting of this project was Almasif Primary Health Care Center, located in Northern Riyadh, Saudi Arabia. The improvement aim was to accelerate the diabetic care follow-up process by removing the non-added value and decreasing the long waiting time for HbA1c results to less than 15 minutes on the same day of the visit among at least 80% of patients with diabetes attending Almasif Primary Health Care Center, Northern Riyadh, by November 2018. Methods A multidisciplinary quality team has been formed. The team used several quality tools, such as brainstorming technique, process mapping, and cases-affect diagnosis, among others. Improvement measures included the percentage of patients with diabetes who had their treatment care plan changed due to HbA1c as the outcome measure, and the percentage of patients who had the HbA1c result in 10 minutes as the process measure. Several rapid PDSA (plan-do-study-act) cycles have been conducted to test the change idea of the point-of-care HbA1c testing device. The idea worked well and data have been analyzed and presented on a run chat showing the changes made (PDSA cycles) and improvement over time using the process and outcome measures. Results All follow-up diabetic patients (17 [100%] of 17) got their HbA1c results within less than 15 minutes. And more importantly, more than half (nine [53%] of 17) of the diabetic patients had their treatment plan changed on the same day of the visit. The majority of the diabetic clinic’s nurses were satisfied (eight out of ten) and competent to perform the new task. Conclusion The idea of using the point-of-care HbA1c testing device is very promising to improve the quality and safety of follow-up of diabetic patients at the primary healthcare clinic. It is highly recommended to replicate the idea nationally.