From the 2018 HVPAA National Conference
Susan Vehar (Cleveland Clinic), Matthew Hoscheit (Cleveland Clinic), Chantelle Carneiro (Cleveland Clinic), Shehab Alansari (Cleveland Clinic), Carl Gillombardo (Cleveland Clinic), Faisal Qadir (Cleveland Clinic), Sunny Lee (Cleveland Clinic)
Over one third of adults in the United States are obese. Obesity is a risk factor for diabetes, hypertension, and heart disease. These diseases are among the leading causes of preventable death and amount to over $140 billion in yearly healthcare expenditures.
By implementing daily team safety huddles in our internal medicine resident longitudinal continuity clinic (LCC), we aimed to increase the documentation of obesity by 15% on the electronic medical record (EMR) problem list of obese patients. We anticipated that appropriate documentation would correlate to proper counseling and referral, thereby improving our overall patient care of this high-risk population.
Six senior medicine residents formed a quality improvement initiative at their internal medicine LCC. Obesity is highly prevalent in our patient population, and we were able to readily list several barriers to counseling and treatment. Our initial obstacle was accurate recognition and documentation of obesity. Pre-intervention data was collected by retrospective chart review of patients who presented to resident LCC. Body mass index (BMI) and documentation of obesity in the EMR problem list were noted. Obesity was defined as BMI ≥ 30. The first intervention consisted of the initial team meeting, and data was collected at the end of the post-intervention after one week of resident LCC. The second intervention entailed a brief daily team safety huddle to emphasize improving care for obese patients, and data was again collected at the end of one week of resident LCC.
In the pre-intervention period, 217 patients were seen in resident LCC. Of these, 102 (47%) were obese. Only 44% of these obese patients had appropriate EMR documentation. After our first intervention, residents evaluated 102 patients, 50 (49%) of which were obese. Within one week, accurate documentation increased to 80%. Following our second intervention, 107 patients were evaluated and 63 (58%) had obesity. Documentation improved to 97% after the second intervention.
Obesity is a common problem with significant health implications and cost. We found that implementing a team meeting followed by daily safety huddles dramatically improved the documentation of obesity on the patient EMR problem list. Further data is needed to determine the long-term efficacy of these interventions. Overall, our combined interventions demonstrated substantial improvement in documentation from 44% to 97% using a simple, time-friendly approach. We also noted the team morale was high, and given the noteworthy improvement, we will consider utilizing team huddles for future safety and quality improvements projects.
Implications for the Patient
Team safety huddles are gaining momentum as an effective tool in the inpatient setting to identify and intervene on patient quality and safety issues. We propose that team huddles are an underutilized approach in the outpatient setting and should be implemented in quality improvement projects in residency training programs.