JOINT BASE SAN ANTONIO-LACKLAND, TEXAS –
Eight months ago, three Airmen at the Wilford Hall Ambulatory Surgical Center were tasked to come up with a PICO (phrase, intervention, comparison, and outcome) question to improve patient care. Beginning as a bunch of scribbles on a whiteboard, their innovative idea has evolved into a process estimated to save the 59th Medical Wing $61,000 annually.
The family health clinic team devised a standardization protocol that will increase patient safety and might soon become a standard practice throughout the Air Force Medical Service.
In early March, nurse practitioner Capt. Tara Blackwelder, and medical technicians Airman 1st Class JaCoy Erickson and Airman 1st Class Abbey Goff, had a patient with suspected case of onychomycosis come into the clinic. As they went through their normal routine preparing to treat the patient, the team discussed medications, pricing, necessary laboratory tests and why those tests were needed.
Ultimately, the team needed to decide whether it was more beneficial to treat the patient right away or wait for the laboratory results to come back. Their conversation led to months of research and turned the decision-making process into an evidence-based practice.
To tackle this question, they used a team approach.
“We all supported each other and filled roles that catered to our strengths,” Erickson said. “Capt. Tara Blackwelder spearheaded the project and provided mentorship through every step of the process. Airman 1st Class Abbey Goff was more research savvy, so she led the research portion. And I’ve always been good with computers, so I compiled the data and formatted the presentation.”
Onychomycosis, a fungal infection of the nail, occurs in 10 percent of the general population. Symptoms are usually cosmetic such as discoloration of nail, thickening, and separation from the nail bed; however, for certain at risk groups such as older adults and people with diabetes, onychomycosis may have more severe health complications.
It costs the wing approximately $500 to $1,070 to treat each case; last year, the wing spent a $122,000 providing treatment. The family health clinic averages one new case each week.
The team’s research found that less than 50 percent of patients being treated by providers for onychomycosis received laboratory testing prior to treatment, Erickson explained. Additionally, only 50 percent of nail infections are caused by onychomycosis which makes accurate diagnosis even more crucial for successful treatment.
There are several methods of treating onychomycosis ranging from the preferred method - administering terbinafine (Lamisil) - to removal of the infected nail.
“We generated a protocol that we’re working on transitioning to a staff support protocol so technicians can streamline the diagnosis process and save the clinic money,” said Erickson.
By enabling technicians to perform these initial assessments for confirmation of onychomycosis prior to treatment, the team believed there would be a reduction in treatments performed, which would free up providers’ time and save the clinic money.
The team is now assessing the final outcome aspect of their PICO question. The standardization protocol was implemented in the family health clinic in late October. Data is being gathered to determine if the predicted outcomes will be experienced in the clinic throughout the next year.
For Erickson, it’s about more than saving money.
“We’re also looking at value to the patient, we’re looking at saving them time… getting them the proper treatment they deserve. That’s been a very empowering experience for me,” he said.
Blackwelder said the experience has been inspirational and has increased the drive for process improvement.
“It has been an amazing experience to work with such motivated technicians who are eager to participate in evidence-based care,” she said. “The enthusiasm garnered from this project has empowered us as a primary care medical home team to make continued improvements that will improve the patient care experience.”
The 59th MDW is AFMS’s largest and most productive research facility, with more than 500 active protocols. Additionally, the wing prides itself in finding new ways to enhance the patient experience through process improvement and innovation.
“From the flight level and all way up the chain, we received tremendous support, which helped elevate any concerns and put us in touch with right people to keep the project moving forward,” said Erickson. “I feel empowered by the clinic and everything that the Air Force has done. I am able to make a change in the Air Force and implement ideas I have to improve processes.”