The following example shows how a health care organization developed and tested the use of an electronic registry to improve the measurement of HbA1c.

Plan
The team predicted that a registry of patients with diabetes would improve the measurement of HbA1c. Setting up this system took three weeks. During that time, the organization also established protocols for glucose measurements and ran a trial utilizing patient self-management for home glucose measurements.

Do
The registry was tested for two weeks with one enthusiastic volunteer nurse practitioner and her patients with diabetes. After the diabetes flow sheet was revised to reflect the registry information, the collection went well.

Study
The time spent on completing the flow sheet increased from one minute to two minutes, and it took an additional three minutes to enter data into the registry. Waiting time for diabetic patients increased an average of eight minutes. Of the patients with diabetes, only half had appropriate testing of HbA1c; but after the trial, all of these patients had current values.

Act
After a team meeting with the executive director and the finance officer who also oversees the information system, the health center adapted a scannable flow sheet form. At the finance officer’s suggestion, they added patients’ insurance status to make sure eligible patients were enrolled in Medicaid or Medicare. To cut down on cycle time, the medical records of the diabetic patients were reviewed the night before to identify gaps and to pre-enter data.

Note: The health care organization could run additional PDSA cycles to test ways of using time even more effectively. In addition, the organization could run simultaneous PDSA cycles to test changes in patient self-management of glucose levels.