IMPROVEMENT OF GYN CARE FOR HIV-INFECTED WOMEN
North General Hospital

Project Background

Project Name: Improvement of GYN Care for HIV-Infected Women

HIV Caseload: N/A

Rationale for Selections: External and internal chart reviews identified the need for improvement.

Team Members:

• Medical Director (team leader)
• Director, QA (team facilitator)
• Administrator, AIDS Center (team timer)
• Secretary, AIDS Center (team scribe)
• Associate Director, Dept. of Medicine
• Director, Ambulatory Care Nursing
• I.D. Attending Physician
• GYN Attending Physician
• Nurse, HIV Ambulatory Clinic
• Pap Smear Nurse
• Administrator, Dept. of Surgery

Success Story

Improvement Goal:

• Increase performance of annual pelvic exams from 33% to 100% in 6 months
• Increase documentation of reproductive options from 22% to 100% in 6 months

Methodology: The team identified the following variations (i.e. points of “breakdown”) in the GYN care process:

Systems

• No patient-tracking system
• No system to follow-up abnormals
• Many patients overdue for annual pelvic exam
• Long wait from HIV clinic to GYN clinic

Staffing

• Lack full-time GYN Attending
• Housestaff not trained to do pelvics; no time in schedule for training

Equipment and Materials

• Some exam tables lack stirrups
• Exam room lacks cytobrushes
• Lack of patient education materials regarding GYN care and reproductive options

Changes were designed to address these issues.

Changes Tested:

Systems

• Developed Policy & Procedures and Forms to:
• Log pelvic exams in HIV clinic
• Log results
• Direct lab results to both Ambulatory Care and MD
• Schedule abnormals for GYN clinic follow-up
• Scheduled backlogged patients to GYN clinic immediately

Staffing

• Trained Housestaff to do GYN assessment and Pap smears (one-day training by GYN Attending)
• Schedule set by Chief Resident
• AIDS Center Medical Director began monitoring Housestaff to ensure they perform GYN exams when patient is due

Equipment and Materials

• Nursing Care Coordinator began ensuring exam rooms are set up for Pap smears and started ordering cytobrushes
• Staff-created flyer (English/Spanish) emphasizing importance of GYN care for all women and special risks for HIV-infected women

Baseline and Follow-up Data:

• The percentage of pelvic exams/Paps performed increased from 17% (2nd quarter, 1995) to 78% (2nd quarter, 1996).
• The documentation of reproductive options discussed increased from 22% (2nd quarter, 1995) to 89% (1st quarter, 1996).

Summary

Next Steps:

• Focused chart reviews conducted in August 1996 (5 months later) to check progress.
• GYN quality indicators (annual pelvic performed and reproductive options discussed) established as part of AIDS Center’s monthly chart review cycle.
• Progress report and performance review presented at each quarterly AIDS Center Principal Investigator Committee meeting.

For more information, please contact:

Pamela Johnson
Administrative Director
AIDS Center
Submission Date: March 2000
james.pratt@ngsc.org

North General Hospital
1879 Madison Avenue
New York, NY 10035
(212) 423-4481 (phone)
(212) 423-4045 (fax)