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Shifali Arora, MD

The effectiveness of endoscopy procedures often depends as much on what happens before the patient comes in for the exam as it does on the skill of the provider. Inadequate preparation can lead to the canceling of procedures, rescheduling and repeating of tests. This not only costs money, it inconveniences the patient. Earlier this year, Shifali Arora, MD, began working on a VCAG (Value Care Action Group) project to improve endoscopy workflows. To date, the project has yielded several valuable tools that are improving education for patients as well as communication among care teams.

Educational Booklet

Studies show the quality of bowel preparation for inpatient procedures is often poor. Arora partnered with Rachel Swier, a fourth-year medical student in the Clinician Leadership in Quality and Safety Scholarly Concentration, to understand the contributing factors.

“Rachel and I rounded together, and we asked patients what could be done better, and what information would help them feel better prepared for their endoscopy procedures,” Arora said.

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Left to right: Rachel Swier (4th year medical student), with infectious disease fellows Caroline Barrett, MD, and Sonia Abichandani, MD

They also instituted a formal patient survey, to gain subjective feedback. This research was then used to create an educational patient booklet, a guide to prepping for an endoscopy procedure.

Order Set in Epic

An order set is a systematic way to order all of the necessary components associated with effective clinical care, for taking care of a patient. Order sets have been shown to improve outcomes and adherence to evidence-based guidelines, along with enhancing both patient care and the provider experience.

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High-value is defined by the quality of patient-centered care achieved per unit of cost, derived from measuring health outcomes against the cost of delivering the outcomes.

Arora partnered with Caroline Barrett, MD, a gastroenterology fellow, to create a new endoscopy order set in Epic. They are currently piloting the new order set and receiving feedback from providers.

Pre- and Post-Procedure Checklist

As part of the larger initiative to reduce delays in discharge due to inadequate prep, the VCAG project focuses on optimizing communication between team members. A pre- and post-procedure checklist in Epic now offers a systematic way to provide information to a team, to help facilitate optimum patient care.  Fellow Sonia Abichandani, MD, helped design the checklist.

“This is a list that outlines when to stop and start a blood thinner, when to order a prep, medication or lab work,” said Arora.  “The goal is to help clinicians assess and follow care guidelines that are appropriate for each patient.”

These tools combined are enabling resources to be better allocated, which can lower the burden on patients by minimizing the need for them to come back a second time.   

“Our goal is to ensure a high level of patient care can progresses efficiently, while reducing length of stay.”

VCAG’s quality improvement interventions will continue to focus on optimizing communication between team members and effective patient education.

About Value-Care Action Group

VCAG encourages the review of current practices, looking for improvements for high-value outcomes in healthcare. High-value is defined by the quality of patient-centered care achieved per unit of cost, derived from measuring health outcomes against the cost of delivering the outcomes. Ron Falk, MD, chair of the department of medicine, created the Value-Care Action Group (VCAG) in 2016 and appointed value-care champions in each medicine division. VCAG projects have included the outpatient diuresis clinic, the inpatient diabetes management service and a patient education initiative that has improved care for cancer patients while reducing unnecessary visits to the ED. New VCAG awardees and projects for FY-2022 were recently announced. Scott Keller is the director of business development keeping the team focused on value-oriented care models. Darren DeWalt, MD, serves as medical director for the team and helps define the projects. John Vargas is the project manager.