Implementation of Pregnancy Checklist into Clinic Workflow: A Quality Improvement Initiative

Study Objective: This project aims to implement the Pregnancy Reasonably Excluded Guide in an outpatient family planning teen clinic using the EPIDEM quality improvement (QI) framework. Design: Quality improvement. Setting: Outpatient family planning teen clinic in an urban center. Participants: Female teen clinic patients (13-19 years of age). Interventions: We used the EPIDEM (Explore relevant issues and contextual factors, Promote to the right people, Implement timely solutions, Document steps, Evaluate with meaningful measures, Make modifications to improve interventions further) QI framework to implement the Pregnancy Reasonably Excluded Guide in our clinic. Main Outcome Measures: The primary outcome was the percentage of eligible visits in which the checklist was used. The secondary outcome was the percentage of encounters in which a UPT was ordered pre- and post-implementation. Results: A total of 383 eligible encounters were reviewed pre- and post-implementation. Before implementation, there was no use of the checklist in clinic. After implementation, 81.8% of eligible encounters used the checklist. Before implementation, 37.3 % of encounters had a UPT ordered. After implementation, 27.0% of encounters had a UPT ordered; there was a 27.6% decrease in UPTs ordered (P = .036). Conclusion: The pregnancy checklist can be successfully implemented using QI methodology, and the EPIDEM QI framework is a valuable clinical tool for the implementation of a context-sensitive protocol. Use of the pregnancy checklist is standard of care and has the capacity to reduce the number of unnecessary UPTs, which may provide time and cost savings in a broad range of clinical settings.