title: Improving the Rate of Colposcopy in an Urban Population of Patients With Known Abnormal Pap Smears.
abstract: This project was designed to improve the colposcopy rate in an urban patient population with known abnormal Pap smears within 75 days of the test to rapidly identify and treat premalignant lesions. Using Plan-Do-Study-Act cycles, Lean techniques, and the electronic health record, the authors created a protocol to verify all Pap smears, then created a process whereby a phone-triage team contacted patients with abnormal Pap smears to educate them and schedule colposcopy. As a result, 100% of Pap smears were verified, compared with 95% prior to plan implementation. The mean time from Pap to colposcopy was 38.5 days, with 85% of patients having colposcopy performed after plan implementation, compared with 50% prior-a 70% improvement. If patients with medical contraindications were excluded, the percentage rose to 91%-an 82% improvement. Patient and provider satisfaction improved, staff and provider workload did not increase, and there was the potential for substantial economic savings.
authors.affiliation: Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA Joseph.Montella@jefferson.edu.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Montella
authors.affiliation: Jefferson School of Population Health of Thomas Jefferson University, Philadelphia, PA.
authors.forename: James F
authors.initials: JF
authors.lastname: Pelegano
mesh_terms: D000328:Adult; D003127:Colposcopy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D058996:Quality Improvement / Q000458:organization & administration; D013997:Time Factors; D014218:Triage; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Lean; PDSA; colposcopy; electronic medical record; performance improvement