The following example shows how a health care organization developed and tested the use of an electronic database to increase the appropriate testing of CD4 counts.

Plan
The team predicted that developing and using an electronic database that included clinical information about patients living with HIV/AIDS disease, combined with an easy-to-use flow sheet, would increase the appropriate testing of CD4 counts. The health center also tested the use of an adherence assessment tool and distributed updated treatment guidelines to all providers.

Do
A free electronic database was downloaded and tested for two weeks with one enthusiastic volunteer provider and her patients with HIV/AIDS disease. After the flow sheet was revised to capture the appropriate information for the database, the data collection proceeded well.

Study
Of the patients with HIV/AIDS disease, only 75 percent of patients had appropriate testing of CD4 levels prior to the institution of the electronic database. After the trial, more than 95 percent of patients with HIV/AIDS disease had current CD4 counts.

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 they had learned about from colleagues. To cut down on cycle time, the patients’ medical records were reviewed the night before the visit to identify gaps and to pre-enter data. Waiting times were reduced to previous levels, but the percentage of patients with current CD4 counts remained above 90 percent.

Note: The health center could run additional PDSA cycles to test ways of using time even more effectively. In addition, the health center staff could run simultaneous PDSA cycles to test changes in patient adherence and provider use of treatment guidelines.