O'Laughlin, Danielle

Background Despite advances in cervical cancer screening, cervical cancer rates have been increasing in the last decade. Hispanic women have higher cervical cancer incidence and mortality rates compared to non-Hispanic women in the United States. These disparities are primarily due to language barriers experienced in this Spanish-preferred population. Our study aims to improve cervical cancer screening rates among Spanish-preferred patients through a Spanish-language multimedia presentation on cervical cancer screening. Methods In patients not adherent to U.S. cervical cancer screening guidelines, we conducted a non-randomized study comparing standard care in Family Medicine (FM) to standard care plus a multimedia presentation with Spanish voiceover intervention in Internal Medicine (IM). We evaluated whether baseline characteristics differed between the two study arms using the Wilcoxon rank sum test and either the Chi-Square test or Fisher’s exact test. For the primary goal, we examined whether there was a difference in screening scheduling rates between the intervention and standard care groups using the Chi-Square test. Using descriptive statistics, we investigated whether there was a difference in characteristics for those who scheduled screening and those who did not. Results We had 52 patients in IM and 58 in FM, differing in age and insurance status, with median ages of 45.5 and 40.0, and percent insured of 65.4% and 82.8%. Post-study, 25.0% (13/52) in IM and 15.5% (9/58) in FM scheduled cervical screening appointments, which was not significantly different, p=0.21. Patients who scheduled screening had higher rates of insurance coverage, at 95.5% compared to 69.3%. Conclusion No statistically significant difference in scheduling rates among Spanish-preferred patients was observed in this study. Further efforts should include larger samples and randomization.

OBJECTIVE This study aimed to assess the need for practice-wide quality improvement to support evidence-based type 2 diabetes screening for women with a history of gestational diabetes mellitus (GDM) receiving primary care. We sought to add the diagnosis of GDM to the problem list of women who did not have it at baseline. RESEARCH DESIGN AND METHODS We identified all women in our practice with a history of GDM diagnosed between 2002 and 2023, quantified the proportion with GDM documented in their problem list, and examined patient- and clinician-level factors associated with having GDM appropriately documented at baseline. RESULTS We identified 203 women with GDM receiving primary care within internal medicine. Of the 203 women, 73 (35.0%) did not have GDM documented in their problem list. Of those without GDM included on the problem list, 52% were overdue for type 2 diabetes screening compared with 41% of those with GDM documented before our intervention. We found race, parity, and previous abnormal glycemic laboratory test results to be highly predictive of whether the history of GDM was on patients’ problem list. Upon completion of our intervention, we successfully achieved a 100% documentation rate for GDM diagnosis for women who previously lacked documentation in their problem list. CONCLUSION This work paves the way for targeted interventions aimed at improving care for women with a history of GDM, including delivery of interventions and education to prevent the onset of an appropriate clinical screening for type 2 diabetes.

Background Physiological monitoring systems, like Masimo, used during inpatient hospitalisation, offer a non-invasive approach to capture critical vital signs data. These systems trigger alarms when measurements deviate from preset parameters. However, often non-urgent or potentially false alarms contribute to ‘alarm fatigue,’ a form of sensory overload that can have adverse effects on both patients and healthcare staff. The Joint Commission, in 2021, announced a target to mitigate alarm fatigue-related fatalities through improved alarm management. Yet, no established guidelines are presently available. This study aims to address alarm fatigue at the Mayo Clinic to safeguard patient safety, curb staff burnout and improve the sensitivity of oxygen saturation monitoring to promptly detect emergencies. Methods A quality improvement project was conducted to combat minimise the false alarm burden, with data collected 2 months prior to intervention commencement. The project’s goal was to decrease the total alarm value by 20% from 55%–85% to 35%–75% within 2 months, leveraging quality improvement methodologies. Interventions February to April 2021, we implemented a two-pronged intervention: (1) instituting a protocol to evaluate patients’ continuous monitoring needs and discontinuing it when appropriate, and (2) introducing educational signage for patients and Mayo Clinic staff on monitoring best practices. Results Baseline averages of red alarms (158.6), manual snoozes (37.8) and self-resolves (120.7); the first postintervention phase showed reductions in red alarms (125.5), manual snoozes (17.8) and self-resolves (107.8). Second postintervention phase recorded 138 red alarms, 13 manual snoozes and 125 self-resolves. Baseline comparison demonstrated an average of 16.92% reduction of alarms among both interventions (p value: 0.25). Conclusion Simple interventions like education and communication techniques proved instrumental in lessening the alarm burden for patients and staff. The findings underscore the practical use and efficacy of these methods in any healthcare setting, thus contributing to mitigating the prevalent issue of alarm fatigue.

Background The incidence of cervical cancer has decreased by 70% since the 1950s. Preventative measures include vaccination against HPV strains and Papanicolaou tests. Early identification of cervical cancer through routine screening can significantly improve patient outcomes. Materials and methods At our academic institution, Community Internal Medicine (CIM) Clinic, 63% of female patients aged 21–65 were compliant with cervical cancer screening. The opening of the ‘Saturday Pap Smear Clinic’ sought to address barriers by offering non-traditional appointment times on Saturday mornings with an all female staff. Our aim was to increase the cervical cancer screening rate by 1% within 12 weeks. Our team compared CIM (intervention) and family medicine (FM) (control) compliance rates from September 2021 to January 2022. Messages were sent to the patient indicating non-compliance and offering options to complete screening. Results At the start of this study, 5239 CIM patients were cervical cancer screening non-compliant. Postintervention, cervical screening rates among non-compliant women within CIM improved by 1.2%. The intervention cohort, CIM patients, had a significant improvement in compliance compared with the control group, FM patients. White women between the ages of 50 and 65 comprised the majority of patients who used the ‘Saturday Pap Smear Clinic’. Conclusions The availability of Saturday appointments for cervical cancer screening completion can enhance cervical cancer screening compliance among eligible women. Eliminating barriers for women can improve health outcomes.