Study Objective

This project aims to implement the Pregnancy Reasonably Excluded Guide in an outpatient family planning teen clinic using the EPIDEM quality improvement (QI) framework.

Design

Quality improvement.

Setting

Outpatient family planning teen clinic in an urban center.

Participants

Female teen clinic patients (13-19 years of age).

Interventions

We used the EPIDEM (Explore relevant issues and contextual factors, Promote to the right people, Implement timely solutions, Document steps, Evaluate with meaningful measures, Make modifications to improve interventions further) QI framework to implement the Pregnancy Reasonably Excluded Guide in our clinic.

Main Outcome Measures

The primary outcome was the percentage of eligible visits in which the checklist was used. The secondary outcome was the percentage of encounters in which a UPT was ordered pre- and post-implementation.

Results

A total of 383 eligible encounters were reviewed pre- and post-implementation. Before implementation, there was no use of the checklist in clinic. After implementation, 81.8% of eligible encounters used the checklist. Before implementation, 37.3 % of encounters had a UPT ordered. After implementation, 27.0% of encounters had a UPT ordered; there was a 27.6% decrease in UPTs ordered (P = .036).

Conclusion

The pregnancy checklist can be successfully implemented using QI methodology, and the EPIDEM QI framework is a valuable clinical tool for the implementation of a context-sensitive protocol. Use of the pregnancy checklist is standard of care and has the capacity to reduce the number of unnecessary UPTs, which may provide time and cost savings in a broad range of clinical settings.

中文翻译：

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在临床工作流程中实施怀孕检查清单：质量改进计划。

研究目的

该项目旨在使用EPIDEM质量改进（QI）框架在门诊计划生育青少年诊所中实施《怀孕合理排除指南》。

设计

质量改善。

设置

门诊家庭计划青少年诊所在市中心。

参加者

女性青少年诊所患者（13-19岁）。

干预措施

我们使用EPIDEM（浏览相关问题和环境因素，促进合适的人，实现及时的解决方案，文件的步骤，评估与有意义的措施，使修改，以提高干预措施进一步）QI框架实现合理排除指南在我院门诊妊娠。

主要观察指标

主要结果是使用清单的合格访问的百分比。次要结果是在实施前和实施后命令UPT的遭遇百分比。

结果

在实施之前和实施之后，总共对383次符合条件的接触进行了审查。在实施之前，临床上没有使用检查表。实施后，符合条件的遭遇中有81.8％使用了清单。在实施之前，有37.3％的遭遇事件安排了UPT。实施后，有27.0％的遭遇事件安排了UPT；订购的UPT减少了27.6％（P  = .036）。

结论

可以使用QI方法成功地完成妊娠检查清单，并且EPIDEM QI框架是用于执行上下文相关协议的有价值的临床工具。怀孕检查表的使用是护理的标准，并具有减少不必要的UPT数量的能力，这可以在广泛的临床环境中节省时间和成本。