Background:
Patient notification is a standard of patient care; 90% of patients want to be informed of all test results (1,2). Patients not receiving results in a timely fashion could be considered unethical (3). Having a standardized process can ensure providers do not miss critical test results (4). At our pediatric obesity clinic, patient notification of lab results was provider-dependent, variable, and often delayed until follow-up. The purpose of this project was to create and evaluate a standardized process of patient notification of lab results at our clinic. Our specific aim was to increase the percentage of new eligible patients having lab letters sent to them from 0% to 90% by August 31, 2020.

Methods:
This project was conducted at the ECU Pediatric Healthy Weight Clinic with the two clinic providers, A and B. After initial chart review, process map analysis of provider workflow, and collection of staff feedback, we decided to pilot a letter process. The intervention population consisted of new clinic patients who had lab work done with two or more lab results; “clinic performed” labs were not included. Our outcome measure was the percentage of patients with lab results “communicated”, defined as the letter being created by the provider and documented in the patient chart. We collected our outcome measure monthly from October 2019 to August 2020. A feedback survey was also conducted via phone for patients from February 2020 who were sent letters. All data was captured via manual chart review, de-identified, and stored in a spreadsheet. Data was analyzed using Microsoft Excel and a run chart was created using R.

Results:
During the 11-month project, charts of 155 new patients were reviewed (average, 13 per month; range, 0-25). 127 patients were eligible to receive letters, and letters were completed for 110 of them (87%). The average letter completion rate was 92% for Provider A (based on 10 months of data) and 73% for Provider B (based on 6 months of data). The survey had a 40% response rate (6 out of 15). 50% of respondents reported having received a letter, with an average satisfaction rate of 4 out of 5. 83% of respondents endorsed wanting to receive all lab results and 100% said they prefer a letter format.

Discussion/Lessons Learned:
Our aim to achieve an average communication rate of 90% was reached by one of two providers. However, Provider A had more intervention months than Provider B. Our project is important because there is no set standard for appropriate communication of labs in the ECU outpatient setting. Our project results, combined with positive patient feedback, suggest mail notification could be useful for the ECU outpatient population. Although EHR patient portals are preferred (5), it has been well-documented that minority patients and patients with limited health literacy, education, and/or income are less likely to use portals (6). This was the case for our patient population, as we found inconsistent MyChart enrollment in our initial chart review. Future PDSAs to help achieve sustainability include improving provider workflow and documentation of letters being sent out.

Conclusion:
We aim to improve patient care at our pediatric obesity clinic by increasing the percentage of patients notified about lab results from 0% to 90%. After an initial chart review showing sparse notification rates as well as inconsistent online portal use, we piloted a letter to be mailed to patients. The average letter completion rate was 92% for Provider A and 73% for Provider B.

Figure 1