P2.277: Improvement in lab result follow up and documentation in outpatient department of a community hospital by the residents

Purpose/Objectives: Lab documentation gaps threaten patient safety. This project seeks to raise resident documentation to 90% by March 2025, boosting accountability. Improved documentation will mitigate delayed diagnoses and miscommunication in ambulatory care settings.

Design/Methods: Baseline Data Collection:
1. Anonymous Resident Survey:
◦ Do you follow up on lab results ordered in the clinic?
◦ Do you document it in the patient's chart?
◦

Results: 12.5% of residents self-reported following up, but documentation rates remained unclear.
2. Chart Review (September–October 2024)
◦ A retrospective review of charts was conducted over 4 weeks.
◦ Lab follow-up documentation was assessed for labs ordered by residents.
◦ 0% of reviewed charts contained documented lab follow-ups.

This project follows the Plan-Do-Study-Act (PDSA) model with multiple cycles to assess and improve lab follow-up documentation.

Cycle 1: Resident Education on Lab Documentation (Oct 2024)
Plan: Educate residents on lab follow-up importance and introduce a documentation template.
Do: Residents use the standardized addendum template.
Study: Post-training chart audits to assess documentation rates.
Act: Revise training materials based on feedback.

Cycle 2: Implementation of a Lab Tracking Tool (Dec 2024)
Plan: Introduce an Excel-based tracking tool for ordered labs and follow-ups.
Do: Require residents to log labs in the excel sheet
Study: Compare pre- and post-implementation documentation rates; collect resident feedback.
Act: Modify tool or explore digital integration.

Cycle 3: Visual Reminders (Feb 2025)
Plan: Place posters in resident workspaces as documentation prompts.
Do: Deploy visual reminders across common areas and computer stations.
Study: Measure engagement and compliance changes.
Act: Expand or refine reminders based on effectiveness.

Results: The QI project led to a notable increase in lab documentation following three PDSA cycles. We had 14 points on our run chart not lying on the median and 6 runs. Initially at baseline (0%), documentation fluctuated but eventually surpassed the median (20%). PDSA 1 resulted in a temporary increase to 20%, quickly followed by a return to baseline. PDSA 2 yielded a more substantial rise to 60%, but again, sustainability was not achieved. Finally, PDSA 3 showed a similar transient peak, reinforcing the challenge of maintaining consistent improvement. Despite these iterative attempts, the 90% target remained unmet, highlighting the need for a deeper analysis of underlying barriers and more effective, sustainable interventions.

Conclusion/Discussion: This QI seeks to establish a sustainable culture of lab follow-up documentation among residents. Early interventions, including resident education, standardized documentation templates, and tracking tools, have shown promise in improving documentation rates. Further enhancements through EMR modifications and automation are expected to solidify these improvements, ensuring a more effective patient care.