PPD IMPROVEMENT
The Brooklyn Hospital Center

Project Background

Project Name: PPD Improvement

HIV Caseload: 700 (late 1998)

Rationale for Selections: After reviewing the results of the first performance data collection for the HIVQUAL Project in 1998, the PATH Centers’ Performance Improvement (PI) Committee chose the placing and reading of PPDs as their first improvement project.

Team Members: All PI Committee members, including:

• Dan Sendzik, team leader and Director of the PATH Center
• Angela Douglas, Senior Staff Nurse at the PATH Center
• Leonard Berkowitz, Chief of Infectious Diseases at Brooklyn Hospital

Success Story

Improvement Goal: To increase the percentage of charts documenting PPDs placed and read from 68% to 85%

Methodology: An investigation of the process was performed using brainstorming, run charts, and cause-and-effect diagrams. The conclusions that were reached pointed to three primary problem areas:

• No individual staff person was clearly assigned responsibility for tracking and following up on PPDs.
• The house staff of the hospital rotate through the PATH Center and are not familiar with the PPD requirement.
• Patients do not return in 48 hours for the reading.

Two rounds of interventions were tested and implemented to help address these areas.

Changes Tested:

First Round Interventions:

• Clinical Case Managers were assigned the responsibility of flagging the charts of patients due for PPD.
• The Senior Staff Nurse was given responsibility for planting the test and giving each patient a reminder card.

These interventions were first tested from 1/20/99 to 2/29/99. The results, measured at the end of February and March, showed that PPDs had increased from 68% to 75% and 81%, respectively. The PI Committee reported these results at the quarterly meeting and the decision was made to make the interventions permanent and system-wide.

Second Round Interventions:

• The Senior Staff Nurse called patients on day two to remind them to return on day three.
• By the end of day three, the Senior Staff Nurse called “no shows” asking that they return on day four.

These two additional interventions increased performance to 88% by the end of April 1999.

Baseline and Follow-up Data: The percentage of charts documenting PPDs placed and read increased from 68% in 1998 to 88% by the end of April 1999.

Summary

Lessons Learned: Project work is enhanced by a high level of staff motivation, open lines of communication, and excellent relationships between patients and staff.

Next Steps: Add PPDs to a list of indicators monitored every quarter, with results reported to the PI Committee for evaluation.

For more information, please contact:

Dan Sendzik, Director, The PATH Center
dps9001@nyp.org
Submission Date: 1999

The Brooklyn Hospital Center
Box 197, 121 DeKalb Avenue
Brooklyn, NY 11201
718-940-5934 (phone)
718- 940-5515 (fax)