AACE Advancing Immunization Quality Improvement Communication Platform-AACE - UNLV Health Workflow Assessment Final Report

AACE - UNLV Health Workflow Assessment Final Report - July 2023

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The University of Las Vegas Nevada (UNLV) Health conducted a workflow assessment to improve vaccination rates among its predominantly underserved diabetic patients in their endocrinology clinic. This endeavor is part of a larger CDC-supported initiative called Advancing Adult Immunization Quality Improvement Projects.<br /><br />### Background<br />The initial workflow was mapped and assessed to understand the reasons behind the low vaccination rates and how to integrate the CDC’s Standards for Adult Immunization Practices (SAIP) into the clinic processes. The clinic employs endocrinologists, a diabetes educator, medical assistants, and administrative staff. The interdisciplinary team participated in a root cause analysis to uncover workflow inefficiencies and offered input on creating an ideal flowchart for patient visits.<br /><br />### Preparation<br />Insights from a fishbone diagram and workflow representations were shared among the staff a week prior to the assessment. The team was instructed to consider areas for incorporating the SAIP to drive higher vaccination uptake.<br /><br />### Participants<br />The workflow assessment included 2 physicians, a diabetes educator, an Electronic Health Record (EHR) analyst, administrative and front office staff, medical assistants, and clinic administrators.<br /><br />### Workflow Assessment<br />Facilitated by the American Association of Clinical Endocrinology (AACE) and the UNLV project team, the workflow assessment began with introductions and an overview of the project and the grant. Staff were encouraged to contribute ideas on integrating SAIP components into the workflow, which were documented using color-coded post-it notes. The key focus areas included assessing vaccination status, recommending, administering, referring, and documenting as part of the workflow.<br /><br />### Key Workflow Changes<br />- **Medical Assistant:** Assess vaccination status during initial patient assessment.<br />- **Provider:** Discuss vaccination during consultation and recommend if not up-to-date; document the decision.<br />- **Front Office:** Update vaccination information in EHR and reconcile with WebIZ.<br />- Implement educational resources like posters and videos in exam and waiting rooms.<br />- Use digital communication tools (e.g., text reminders, MyChart) for updating vaccination records and sending educational materials.<br />- Provide vaccine education for clinic staff and identify a vaccine champion.<br /><br />### Next Steps<br />The modified workflow will guide the implementation of various quality improvement interventions, with a focus on minimizing impact on clinic efficiency. Further measures include regular pop-up vaccine clinics, enhanced communication between primary care providers and endocrinologists, and ongoing staff training.<br /><br />Overall, the refined workflow aims to foster a systematic approach to increasing adult immunization rates in the clinic.

Keywords

UNLV Health

vaccination rates

diabetic patients

workflow assessment

CDC initiative

SAIP

endocrinology clinic

quality improvement

medical assistants

vaccine education