Improving the Rate of Colposcopy in an Urban Population of Patients with Known Abnormal Pap Smears

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Advisor: James Pelegano, MD, MS, Thomas Jefferson University


The purpose of this project was to improve the rate of colposcopy in an urban population of patients with known abnormal Pap smears within 3 months of implementation in order to identify and treat lesions that could progress to cervical cancer. Using a modified PDSA approach and leveraging the functionality of the electronic health record, our working group of patients and representatives from our outpatient office first created a protocol that was implemented by the medical assistants to assure that all Pap smears were verified by the providers. We then created a process by which the providers worked with a nurse-triage team to contact patients with abnormal Pap smears to educate them about their disease and facilitate their colposcopy appointment. The results of the implemented plan demonstrated that 100% of Pap smears were verified by the provider compared to 95% prior to plan implementation. The percent of patients having colposcopy performed after plan implementation was 85% compared to 50% prior to plan implementation, a 70% improvement. If patients who did not have colposcopy performed due to medical indications (i.e. pregnancy) were excluded from the analysis, the percent having colposcopy rose to 91%, an 82% improvement from pre-project levels. The mean time from Pap to colposcopy was 38.5 days, which was below the target benchmark of 75 days. This project improved patient satisfaction and did not increase the workload of the medical assistants or the providers. By using a modified PDSA approach and leveraging the functionality of the EMR, we improved the rate of colposcopy by 70% within three months of plan implementation and also improved patient and provider satisfaction.

Presentation: 34 minutes

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