Clinical safety projects improve patient care at UT Medicine

SAN ANTONIO (Jan. 13, 2012) — One patient safety project at UT Medicine San Antonio means that diabetes indicators are more consistently monitored. Another means that fewer patients suffer potentially debilitating falls during outpatient visits.

The projects are among dozens born of a continuing medical education (CME) course and undertaken over the last four years by UT Medicine, the clinical practice of the School of Medicine at the UT Health Science Center San Antonio.

The Health Science Center established the Center for Patient Safety and Health Policy in 2008 under an initiative of The University of Texas System. The patient safety center offers an interdisciplinary course, Clinical Safety and Effectiveness, which is approved for clinician CME.

“The course is generating concrete results because it requires clinicians to design, implement and report results of a clinical effectiveness project, such as the diabetes monitoring initiative or the falls prevention initiative,” said center director Jan Patterson, M.D., associate dean for quality and lifelong learning in the School of Medicine.

In November a national agency, the Accreditation Council for Continuing Medical Education, accredited the school’s CME programs for the maximum six years with commendation. The commendation ranking requires evidence of quality improvement accomplished in projects such as those done in the course.

Making sure diabetic patients are tested
Course participants Marijan Gillard, M.D., and Thwe Htay, M.D., set a goal to improve testing rates for diabetic patients in the UT Medicine Primary Care Clinic. The tests are hemoglobin A1c and urine microalbumin. Hemoglobin A1c strongly predicts diabetes complications; keeping its level under 7 percent reduces blood vessel complications. Microalbuminuria — low rate of urinary excretion of the protein albumin — is the earliest sign of diabetic kidney disease.

More than 1,000 diabetic patients visit the UT Medicine Primary Care Clinic annually. The intervention to increase their testing was simple: flag hemoglobin A1c tests to be done every three or six months depending on the patient’s blood sugar control, and flag the microalbumin test to be done annually, using a computerized reminder system within UT Medicine’s electronic medical record.

“At the time of the project, we improved testing of these two indicators by 15 percent and 25 percent, respectively, and as a result patients’ diabetes was more effectively managed, potentially preventing trips to emergency rooms,” Dr. Gillard said. “We also diagnosed some cases of diabetic kidney disease earlier than would be expected without the testing reminders.”

The reminders are still a part of every visit for any diabetic and are considered to be a useful tool for patient care. Reminders are now used for pneumonia vaccination as well, and soon other health maintenance reminders for procedures such as mammograms, PAP smears or colonoscopies will be available to each UT Medicine provider working in primary care and geriatrics.

Dr. Gillard is an assistant professor in the Department of Family and Community Medicine, and Dr. Htay is an assistant professor in the Division of General Medicine.

Preventing falls at the MARC
Falls are a common source of injury among older adults; in fact, one-third of adults older than 65 will have a fall this year. Falls are associated with decreased function, increased use of medical services and greater chance of going to a nursing home.

UT Medicine created a task force to study falls among patients visiting the Medical Arts & Research Center (MARC), UT Medicine’s flagship practice site in the South Texas Medical Center. Because of what they learned, UT Medicine personnel are vigilant to assist patients in the parking garage, which is 90 feet from the patient elevators. Staff members identify patients who are using assistive devices and offer help, identify obstacles and clear areas, resurface slippery entrances, and take note of visitors with gait and balance problems and other impairments such as poor vision.

This patient safety intervention reduced falls at the MARC by two-thirds, from 4.8 to 1.6 a month. “Tackling a complex problem such as fall prevention required input from everyone who interacts with our patients, as well as those who operate and maintain the building,” said Denise Dahm, M.D., clinical geriatrician with UT Medicine. “Our task force included patients, transporters, environmental safety and facilities personnel, and housekeeping staff, as well as clinical staff. Each member was able to contribute his or her unique perspective as we identified problems and implemented solutions.”

Dr. Dahm is assistant professor in the Division of Geriatrics, Gerontology and Palliative Medicine.

The Clinical Safety and Effectiveness course teaches a pattern that can be applied to improve any number of health care areas. “Plan, Do, Study, Act is our process of improving quality and effectiveness,” Dr. Patterson said. Part of the process involves creating a flowchart that shows all areas of potential intervention.

In addition to projects at the MARC, the course also trains faculty in quality improvement projects at community partner sites in the University Health System, CHRISTUS Santa Rosa Health System and South Texas Veterans Health Care System.

UT Medicine San Antonio is the clinical practice of the School of Medicine at the UT Health Science Center at San Antonio. With more than 700 doctors – all faculty from the School of Medicine – UT Medicine is the largest medical practice in Central and South Texas, with expertise in more than 60 different branches of medicine. Primary care doctors and specialists see patients in private practice at UT Medicine’s clinical home, the Medical Arts & Research Center (MARC), located in the South Texas Medical Center at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and there are clinics and physicians at several local and regional hospitals, including CHRISTUS Santa Rosa, University Hospital and Baptist Medical Center. Call (210) 450-9000 to schedule an appointment, or visit the Web site at for a complete listing of clinics and phone numbers.

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