Other Titles
eScreening Integration in Texas Primary Care Clinics [Poster Title]
Abstract
Background: Primary care clinics often dedicate significant time reviewing screening questionnaires completed by patients to assess preventive care needs and identify possible health conditions. This process not only reduces the time patients spend directly with primary care providers but also increases the documentation burden on nursing staff, detracting from other critical patient care tasks.
Objective: The quality improvement projects aim to reduce the time patients spend with nursing staff collecting information from screening during primary care appointments. This will be accomplished by sending the patient electronic screening (eScreening) that will be completed by patients prior to the appointment.
Methods: The initiative involved implementing eScreening questionnaires, completed by patients prior to their primary care appointments. A six-month pilot was conducted across eight outpatient primary care teams at two health care systems in the Department of Veterans Affairs. The Lean Six Sigma quality improvement methodology guided the design, implementation, monitoring, and iterative improvements through continuous feedback loop. Process efficiency was assessed using Gemba walks, to measure time spent on screenings before and after implementation. Statistical analysis, including paired t-tests, was performed to determine the significance of observed changes.
Results: The response rate for the questionnaires was 49.92% (n=3229). Post-implementation of eScreening, the time spent by patients with nurses for screening during appointments with patients that had completed eScreening questionnaire had a statistically significant decrease (p<0.0001) for veterans that completed the questionnaire.
Conclusion: The introduction of eScreening demonstrated a measurable reduction in documentation time and improved efficiency in primary care clinics. Despite the positive results, the response rate indicated the need for strategies to enhance patient participation. The initiative supports the healthcare system mission to modernize healthcare delivery with scalable and optimized digital solutions.
Notes
References:
1. Filipovic, M. G., Huber, M., & Luedi, M. M. (2022). Electronic screening – of anesthesiologists and algorithms. Journal of Clinical Anesthesia, 82, 110951. https://doi.org/10.1016/j.jclinane.2022.110951
2. Goodness, T. M., & Palfai, T. P. (2020). Electronic screening and brief intervention to reduce cannabis use and consequences among graduate students presenting to a student health center: A pilot study. Addictive Behaviors, 106, 106362. https://doi.org/10.1016/j.addbeh.2020.106362
3. Herd, P., & Moynihan, D. (2021). Health care administrative burdens: Centering patient experiences. Health Services Research, 56(5), 751–754. https://doi.org/10.1111/1475-6773.13858
4. Neprash, H. T., Mulcahy, J. F., Cross, D. A., Gaugler, J. E., Golberstein, E., & Ganguli, I. (2023). Association of primary care visit length with potentially inappropriate prescribing. JAMA Health Forum, 4(3), e230052. https://doi.org/10.1001/jamahealthforum.2023.0052
5. Pittman, J. E., Almklov, E., Angkaw, A., Doran, N., Lindamer, L., Norman, S. B., Grubbs, K., Wolfe, W., & Afari, N. (2021). Electronic screening to support measurement based care: Examples from the field. Military Behavioral Health, 10(3), 235–242. https://doi.org/10.1080/21635781.2021.1994490
6. Pittman, J. O., Afari, N., Floto, E., Almklov, E., Conner, S., Rabin, B., & Lindamer, L. (2019). Implementing escreening technology in four va clinics: A mixed-method study. BMC Health Services Research, 19(1), 1–14. https://doi.org/10.1186/s12913-019-4436-z
7. Pittman, J. O., Floto, E., Lindamer, L., Baker, D. G., Lohr, J. B., & Afari, N. (2017). Va escreening program: Technology to improve care for post-9/11 veterans. Psychological Services, 14(1), 23–33. https://doi.org/10.1037/ser0000125
8. Pittman, J. O., Rabin, B., Almklov, E., Afari, N., Floto, E., Rodriguez, E., & Lindamer, L. (2021). Adaptation of a quality improvement approach to implement escreening in VHA healthcare settings: Innovative use of the lean six sigma rapid process improvement workshop. Implementation Science Communications, 2(1), 1–11. https://doi.org/10.1186/s43058-021-00132-x
9. Porter, J., Boyd, C., Skandari, M., & Laiteerapong, N. (2022). Revisiting the time needed to provide adult primary care. Journal of General Internal Medicine, 38(1), 147–155. https://doi.org/10.1007/s11606-022-07707-x
Serra-Prat, M., Lavado, À., Cabré, M., Burdoy, E., Palomera, E., Papiol, M., & Parera, J. (2022). Development and validation of the electronic screening index of frailty. Age and Ageing, 51(7). https://doi.org/10.1093/ageing/afac161
10. Tansil, K. A., Esser, M. B., Sandhu, P., Reynolds, J. A., Elder, R. W., Williamson, R. S., Chattopadhyay, S. K., Bohm, M. K., Brewer, R. D., McKnight-Eily, L. R., Hungerford, D. W., Toomey, T. L., Hingson, R. W., Fielding, J. E., & Community Preventative Services Task Force. (2016). Alcohol electronic screening and brief intervention. American Journal of Preventive Medicine, 51(5), 812–813. https://doi.org/10.1016/j.amepre.2016.04.012
11. Van den Blink, A., Janssen, L. M., Hermanides, J., Loer, S. A., Straat, F. K., Jessurun, E. N., Schwarte, L. A., & Schober, P. (2022). Evaluation of electronic screening in the preoperative process. Journal of Clinical Anesthesia, 82, 110941. https://doi.org/10.1016/j.jclinane.2022.110941
Sigma Membership
Delta Theta
Type
Poster
Format Type
Text-based Document
Study Design/Type
Quality Improvement
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Implementation Science, Primary Care, Sustainable Development Goals, Patient Electronic Screening, Clinics
Recommended Citation
Sanadi, Thu Nguyet; Leddy, Rita Annette; and Francis, Patricia, "Electronic Screening in Outpatient Clinics to Reduce Clinician Administrative Time" (2025). Biennial Convention (CONV). 35.
https://www.sigmarepository.org/convention/2025/posters_2025/35
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-11-21
Electronic Screening in Outpatient Clinics to Reduce Clinician Administrative Time
Indianapolis, Indiana, USA
Background: Primary care clinics often dedicate significant time reviewing screening questionnaires completed by patients to assess preventive care needs and identify possible health conditions. This process not only reduces the time patients spend directly with primary care providers but also increases the documentation burden on nursing staff, detracting from other critical patient care tasks.
Objective: The quality improvement projects aim to reduce the time patients spend with nursing staff collecting information from screening during primary care appointments. This will be accomplished by sending the patient electronic screening (eScreening) that will be completed by patients prior to the appointment.
Methods: The initiative involved implementing eScreening questionnaires, completed by patients prior to their primary care appointments. A six-month pilot was conducted across eight outpatient primary care teams at two health care systems in the Department of Veterans Affairs. The Lean Six Sigma quality improvement methodology guided the design, implementation, monitoring, and iterative improvements through continuous feedback loop. Process efficiency was assessed using Gemba walks, to measure time spent on screenings before and after implementation. Statistical analysis, including paired t-tests, was performed to determine the significance of observed changes.
Results: The response rate for the questionnaires was 49.92% (n=3229). Post-implementation of eScreening, the time spent by patients with nurses for screening during appointments with patients that had completed eScreening questionnaire had a statistically significant decrease (p<0.0001) for veterans that completed the questionnaire.
Conclusion: The introduction of eScreening demonstrated a measurable reduction in documentation time and improved efficiency in primary care clinics. Despite the positive results, the response rate indicated the need for strategies to enhance patient participation. The initiative supports the healthcare system mission to modernize healthcare delivery with scalable and optimized digital solutions.
Description
A six-month implementation pilot at eight outpatient primary care clinics introduced electronic screenings for patients to complete before visits, aiming to reduce time spent on screenings and ease nursing staff's documentation burden. Guided by Lean Six Sigma, the project showed a statistically significant decrease in screening time (p<0.0001). With a 49.92% response rate, future efforts should focus on boosting patient participation to further enhance efficiency and care delivery.