Integrating a simple screening tool in the electronic medical record to standardize patient needs identification process.

Abstract

156 Background: Unidentified psychosocial and nutrition needs can impede a patient’s quality of life during cancer treatment. Nutritional, social, and logistical patient needs may be overlooked without a standardized identification process. With the increasing use of the electronic medical record (EMR), simple screening tools to identify psychosocial needs and nutritional concerns can be implemented. Methods: The University of Pennsylvania’s Department of Radiation Oncology integrated a simple six-question “yes” or “no” response screen directly into the nursing assessment in the EMR to quickly and easily trigger high-risk patient referrals to social work and nutrition services. The screen identifies multiple patient needs (i.e. home supports, weight loss) in a formalized approach across distinct time periods in the treatment course. Staff collected data on new patient encounters and the subsequent referral source (i.e. screen, physician). Results: For social work, 24.5% of the new patient referrals from July 2013 – February 2014 were triggered via the screening tool in the EMR. While it is not clear from this data that overall referrals to social work increased due to the screening tool, it can be inferred that these patients were identified earlier in the treatment trajectory for supportive services. For nutrition services, 51.2% of new patient referrals were triggered via the screening tool. A comparison of data prior to the implementation of the screen in January 2012 showed a 78% increase in nutrition referrals triggered by the screen. Conclusions: This method facilitates quick intervention and fosters better communication among staff. The screen allows the staff to readdress psychosocial and nutrition impact symptoms on a regular basis and provide appropriate interventions along the continuum of care. The screen also reduces the subjectivity of medical staff referrals and is an additional measure to identify oncology patients who would otherwise be overlooked. Lastly, the screening tool in the EMR denotes a targeted intervention and contributes to the establishment of a supportive patient relationship.

Improving Hepatitis B Screening at Family Health Centers Using Quality Improvement and Electronic Medical Record Tools

“…QI methodology is an effective process to successfully translate evidence-based practices and public health recommendations into clinical workflow so that clinicians "do the right things right" (12). EMR tools have also been demonstrated to improve performance of screening within clinical workflows (13) and in the setting of primary care (14) where time pressures are notable with high competing demands. In our case, we were able to improve HBV screening rates using both QI methodology and implementation of EMR tools.…”