Strelow, Brittany A

To review the anxiety and fear risk factors, pathophysiology, symptoms, screening and diagnosis while highlighting treatment considerations for women undergoing a pelvic examination. Methods: We reviewed the literature pertaining to anxiety and fear surrounding the pelvic examination to help guide health care providers’ on available screening options and to review options for individualized patient management. Results: Anxiety and fear are common before and during the pelvic examination. In fact, the pelvic exam is one of the most common anxiety-provoking medical procedures. This exam can provoke negative physical and emotional symptoms such as pain, discomfort, anxiety, fear, embarrassment, and irritability. These negative symptoms can interfere with preventative health screening compliance resulting in delayed or avoided care and significant health consequences. Conclusion: Assessing women for anxiety related to pelvic examinations may help decrease a delay or avoidance of examinations. Risk factor and symptom identification is also a key component in this. General anxiety questionnaires can help identify women with anxiety related to pelvic examinations. Strategies to reduce anxiety, fear and pain during a pelvic examination should routinely be implemented, particularly in women with high-risk factors or those identified with screening techniques as having anxiety, fear or pain with examinations. Treatment options should be targeted at understanding the patient’s concerns, starting conversations about pelvic examinations early, educating patient’s about the examination and offering the presence of a chaperone or support person. During an examination providers should ensure the patient is comfortable, negative phrases are avoided, the correct speculum size is utilized and proper lubrication, draping, dressing and positioning are performed. Treating underlying gynecologic or mental health conditions, consideration of cognitive behavioral therapy and complementary techniques such as lavender aromatherapy and music therapy should also be considered when appropriate.

165 Background: The Hematology Hospital Outpatient service at Rochester Methodist Hospital provides ambulatory outpatient care to patients who would normally be hospitalized on our inpatient services due to cytopenias and need for infusion/transfusion support. A quality project was conducted to streamline our process and decrease wait times. Methods: This project was a part of a Mayo Lean Collaborative initiative to increase customer satisfaction and eliminate waste. The first step was to collect baseline measurements to capture the non-value added waiting time of our entire outpatient process. These benchmark times were collected from 65 patients over 4 days. We evaluated these wait times to identify gaps in care and factors contributing to delays in our process. Data collected "before and after" each implementation phase determined if the change was beneficial. Results: Through our data collection, one major area of opportunity we identified was the wait time for CBC results. At baseline, patients were waiting in a room for 61.9 minutes for lab results. A major contributor to delay was the lack of carriers to send blood samples through the tube system being stocked in the outpatient area. We also discovered that the time from when the sample was placed in the carrier to the time it arrived in our lab was significant. Through a process analysis it was identified that the CBC tubes were being sent to a central lab prior to their final destination in the Hematology lab. We were able to re-route our CBCs directly to the hem lab. Data collected after the intervention showed we were receiving results at 51 minutes, therefore, eliminating 10.9 minutes off of an appointment. We also identified additional opportunities such as pre-assigning rooms, scheduling, exam room organization, and communication that were able to be addressed. Conclusions: As a result of this lean collaborative project we reduced patient wait time by 20.1 minutes and increased patient satisfaction. We were able to order interventions sooner thereby increasing patient safety. By process analysis, we identified multiple areas in our process that could be shortened with no additional cost.