Vision and Hearing Screening Broadway ACN PDSA 2007-2008.
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Transcript of Vision and Hearing Screening Broadway ACN PDSA 2007-2008.
![Page 1: Vision and Hearing Screening Broadway ACN PDSA 2007-2008.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ee85503460f94bfa42e/html5/thumbnails/1.jpg)
Vision and HearingScreening
Broadway ACN PDSA2007-2008
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AIM statement Ensure effective and proper screening of
hearing and vision of 95% of children age 4-18 years in accordance with AAP guidelines.
Ensure proper referrals of 95% of children who require them.
Ensure pre-screening of 75% of patients
Decrease visit cycle time by 15%
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Why hearing and vision? Vision disorders:
4th most common disability among US children Leading cause of childhood impairment conditions Only 21% of all preschool children are screened Only 14% receive a comprehensive vision exam
Hearing loss:
Most common congenital condition in the US - 33 infants born daily
Congenital deficit may only become evident in childhood Can be acquired during infancy or childhood Post trauma to the CNS, noise pollution, ototoxic drugs
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Guidelines
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American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine. Recommendations for preventive pediatric health care. Pediatrics.2000; 105 :645 –646
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AAP Guidelines: When do I screen?
3 yr.
4yr. 5 yr. 6, 8yr.
10 yr.
11 yr.
12 yr.
13,14 yr.
15 yr.
16, 17 yr
18 yr.
O O O O O S O S O S O
S O O O O S O S O S O
Newborn
1 mo.
2 mo.
4 mo.
6 mo.
9 mo.
1 yr. 15 mo.
18 mo.
21 mo.
24 mo.
O S S S S S S S S S S
S S S S S S S S S S S
S: Subjective screen at every routine visit (i.e.: history)
O: Objective testing
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Referral
• Vision:• 3-5 yo: 20/50 or worse (repeat in 6 months if
uncooperative)• 6 yo and older: 20/40 or worse• Any age with two-line difference between eyes, even
within the passing range (i.e., 10/12.5 and 10/20 or 20/25 and 20/40)
• Hearing:• Air conduction hearing threshold levels of >20 dB at
any of these frequencies• 4 yo onward: each ear tested at 500, 1000, 2000,
and 4000 Hz.
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PDSA Cycles
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Baseline measurementsBrooke Davey
• Average visit time: 3 hours 4 minutes
• Appropriately screened:• Vision: 91% (39/43)• Hearing: 91% (39/43)
• Abnormal results referred:• Vision: 25% • Hearing: N/A (no abnormal screens)
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DidacticStephanie Marion
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Didactic cycleA.k.a Eclipsys crash cycle, Tom Hooven
• Appropriately screened :• Vision: 94% (17/18)• Hearing: 91%
• Abnormal results referred:• Vision: 25% (1/4)• Hearing: N/A (no abnormal screens)
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Tom Hooven cycle
What: provider pre-ordering hearing and vision in Eclipsys the day before patient comes for appointment
Who: one patient and one provider
Result: did not work as “pending return visit” orders not monitored by MAs
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Katie McGuinn cycleNovember-December
• What: Effective identifying of patients in need for pre-screening:
• Identification of eligible patients by providers, marked on tallies for PFAs to see
• Eclipsys orders entered• Pink box on cover sheet attached to front of chart for
MAs to recognize
• Who: Resident clinic (half a day)• Result: Did not work – Labor intensive
• Appropriately PRE-screened :• Vision: 40% (4/10)• Hearing: 60% (6/10)
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Erik Jensen cycleJanuary
What: Eliminated need for provider and PFA involvement Established age-based guidelines as to which patients
would be pre-screened: Vision: Any pt 4-18 years in clinic for regular
appointment (no walk-ins) unless pt/guardian admits to testing within past 6 months.
Hearing: Any pt 4-10 years in clinic for regular appointment (no walk-ins) unless pt/guardian admits to testing within past 6 months
Who: Resident clinic (2 half days) Results: Improved results but not at goal yet
• Appropriately PRE-screened:• Vision: 67% (4/6)• Hearing: 67% (4/6)
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Meg Sullivan cycleFebruary
What: Signs placed in MA’s office Signs for provider offices and consultation 4 day retrospective analysis
Who: All providers
Results: Confirmation of improvement Appropriately PRE-screened:
• Vision: 84% (43/51)• Hearing: 84% (43/51)
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Emily Kaufman final chart reviewApril – over 2 weeks, all providers
• n = 72
• Average visit time: 2 hours 29 minutes
• Appropriately screened:• Vision: 89% (64/72); 98.5% pre-screened• Hearing: 84% (36/43); 97% pre-screened
• Abnormal results referred:• Vision: 70% (18/26) • Hearing: 0% (0/1)
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Summary
Baseline Post-didactic Final chart review
N 43 18 72
Vision screen 91% 94% 89%
Hearing screen
91% 91% 84%
Average cycle time
3 h 4 min N/A 2 h 29 min
Vision referral when
abnormal
25% 25% 70%
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Future Plans Staff education planned with
Ophthalmologist Michael Chiang M.D. to review vision screening methods
Find ways to decrease cycle time even more (i.e.: redesign, pairing M.A with provider, etc)
Ensure that providers are actually looking at results of screen by importing flow sheet into note
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Chart review of past projects
Domestic Violence at Newborn, 1 y.o. visits (2006-2007): 45% screening (7/16; 6/10 of newborns screened and only
1/6 of 1 yo)
Blood pressure documentation (2005-2006): 73% of charts (32/44)
Screen time documentation (2004-2005): 0% (0/32)
BMI (5yo-19yo): 14/34 with elevated BMI, 50% documented
intervention
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Thank you PFAs:
Evelyn, Kenya, Carlos, Conchita
R.Ns: Haydee, Catherine, Bridget, Sally
M.Ds/N.Ps: Mariellen Lane, Pran Saha, Laura Robbins-Milne,
Renie Eis, Heidi Beutler, Nan Salamon, John Rausch
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Thank you The ACN Broadway residenCE:
Katie McGuinn, Brooke Davey, Stephanie Marion
Lindsey Tilt, Cyril Sahyoun, Taryn Wiley-Rio Sangita Patel, Meg Sullivan, Jennifer Louis-
Jacques Emily Kaufman, Deena Blanchard, Tom
Hooven Eva Cheung, Emily Rothbaum, Erik Jensen
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