Editors’ Note: This summer, six students from Albert Einstein College of Medicine traveled to Soroti, Uganda, as part of Einstein’s Global Diabetes Institute (GDI), to treat diabetes in a part of the world where 693,200 cases of diabetes were reported in 2014. This is the latest in our series of posts detailing the students’ challenges and progress. In this one, second-year M.D. student Dariusz Hareza shares his experiences taking part in a GDI diabetes education and prevention effort. The trip was funded by Einstein’s Global Health Fellowship Program.
In Soroti, at a diabetes clinic belonging to the Soroti Regional Referral Hospital in Uganda, I had the privilege of contributing to the improvement of patient care by standardizing the intake forms that contain patient information gathered at each visit (height, weight, waist circumference, blood pressure, fasting blood glucose, and the like).
Better Records for Better Care
The idea behind the forms was to have all of the most important patient information in a single place, in a simple-to-read format that the doctors could rely upon. Previously, the doctors had to flip through booklets full of handwritten notes. Important values could be lost among the scribbles of medical histories and chief complaints. It was also difficult to get a sense of the time that had elapsed between tests and treatments.
Our goal was to create a form that the nurses could easily fill out, the doctors intuitively read and the technicians efficiently convert to electronic formats in the future, all of which would significantly improve patient care.
Information: When Less Is More
We presented the forms to the faculty and interns for their input. However, once they were given to the staff, the forms got off to a rocky start. Nurses did not always fill out each of the categories and I had to send patients back to get their height and weight taken. I often ended up taking their pulses and calculating their body-mass index results myself. Other staff members were experiencing the same difficulties.
Clearly, the forms needed adjusting. The system would work well only if everyone filled out the charts completely and consistently. Some doctors complained about how long it took to fill out the forms. Without an electronic medical records system in place, it was difficult to show them the importance of standardization. With these complaints in mind, we updated the forms to minimize the amount of repetitive writing the doctors had to do and we edited the forms to include only the most common lab tests and medications.
The Power of Patient Data
The changes seemed to work. There was less complaining and the forms were being used by the staff regularly. I even witnessed the benefit of the forms firsthand. In our third week at the clinic, a young woman came into the room and walked straight over to me. The patient gave me her papers, and I recognized her from a previous visit.
I glanced at her chart and saw that she had in fact been there the previous week. Looking at the papers reminded me of my alarm over her high levels of fasting blood glucose. At the time, the glucometer showed “HI,” which meant the sugar level was beyond what the instrument could measure. Her HbA1c was also >14%, indicating that she had had uncontrolled blood-sugar levels for the past three months. However, the forms made it simple for me to see the difference in sugar levels between the previous week and the current week.
Good news! Her fasting blood sugar was just where we wanted it. I looked back at the young woman and she was beaming at me. I told her, “Your sugar levels are great. What changed since I last saw you?” She replied that she had followed the diet I told her about and had taken her medication as prescribed. I felt so proud of her. She had realized how important it was for her to eat properly and take her medications after I made it clear how dangerous it was to have such high sugar levels. The forms allowed me to show her where she was in her treatment and where she needed to be in her struggle against diabetes.
She then took her health into her own hands and came back with positive results. I made sure to express how well her changes had worked and indicated that she needed to continue in order to get long-term benefits.
So with a combination of the new intake forms and patient education, there is now an opportunity for patient visits to this clinic to become more efficient. Most important, patients can better influence their own health as they’re shown their progress through time.
