WS19.1 Using microsystems methods to improve nutritional outcomes in an adult CF center: a quality improvement (QI) initiative

Abstract

Objectives: A global aim was to become one of the top 10 best performing centers in the US based on pulmonary and nutritional data; our specific aim is to reduce the percentage of patients at nutritional risk not seen by our registered dietician (RD) by 10% over a 3 month period (quarter #3, 2011). We chose this project because, based on our center specific data from the CF Foundation registry, at our program the percentage of patients at nutritional risk seen by a dietician (58%) was well below the national average (82%). Methods: We assembled an interdisciplinary core team consisting of dietician, social worker, physicians, and nurse practitioner; a 5-member patient advisory board was recruited to identify patients’ priorities for improvement. We used the Plan-DoStudy-Act (PDSA) approach. PDSA #1: examination of our clinic flow, to identify any inefficiencies. Flow started with our Monday team meeting, and ended with our after-clinic wrap-up. Our Monday meeting was used to target patients for RD to see that week. Over a 3-month period we were able to identify and intervene for those patients needing dietician expertise. Conclusions: Our data reflected a significant improvement: in quarter3, 2011 (30%) compared to the annual data from 2009(58%). Lessons learned included standardizing the way in which heights and weights are recorded; focusing our team meeting; implementing changes in clinic flow (process). These lessons are included as standard procedures (“playbook”). PDSA #2: survey of patients to identify their priorities for our process. PDSA#2 data are pending. Lesson learned: patients are eager to participate in our program QI. Supported by CFF AQI2.