Implementation
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Implementation. Logistics What we used to do What we did this year How it turned out What we would do different. TB Screenings. Of our about 3600 students, 2000 are mandated to have annual TB screening

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Implementation

Implementation

Logistics

What we used to do

What we did this year

How it turned out

What we would do different


Tb screenings
TB Screenings

  • Of our about 3600 students, 2000 are mandated to have annual TB screening

  • ECSHC Immunization compliance is driven by the CDC recommendations for Health Care workers, Los Angeles County Hospital immunization requirements, Children’s Hospital of Los Angeles, as well as other facilities requirements for immunization compliance


Ppd parties
PPD Parties

  • All TB screening done in the month of April

  • Each school had an assigned day and time for placement and reading

  • Remote placement and reading of PPD

  • Considerations for remote placement

    -Staff -Time

    -Supplies -Space



  • What the tb screening with the ppd test cost in 2009 2010 academic year

    What the TB screening with the PPD test cost in 2009-2010 academic year

    Medication $120

    Chest Xray $ 7,500

    Supplies $ 70

    INH Tx $ 117 per person (x 5)


    Igra time line
    IGRA Time Line

    • March 2010:Offered to students at cost 15%

    • July 2010: CDC/MMWR updated guidelines on use of IGRA’s

    • Sept 2010: Student Insurance agreed to cover test at 90% with deductible waived

    • Sept 2010: Mandated for the following students:

      • History of +PPD

      • History of BCG vaccine

      • Born outside of United States


    Which igra did we choose
    Which IGRA did we choose?

    • We chose T-Spot due to

      • Financial considerations

      • Availability of test

      • Availability of Service Representatives

      • Used by other campus of USC



    Getting the word out
    Getting the word out

    • Blast emails to students

    • Educate departments of policy change

    • Work with departments to inform students

    • Screening forms for TB screening test

    • Article in our newsletter

    • Flyers in the exam rooms and on campus



    What about the ppd parties
    What about the PPD Parties

    • We still offered the PPD parties to the departments

    • Arrange staff lunches around the PPD party

    • Decrease clinicians appt. during PPD parties

    • All students completed screening form to identify those who need the IGRA test



    What did the t spot cost us this year

    What did the T-Spot cost us this year?

    Out of Pocket tests $7,000

    Increase staff $ 1,560

    INH Tx $117 per person (x10)

    Chest Xray $1,705

    Supplies $100


    What did we not anticipate
    What did we not anticipate?

    • Increase time for lab processing

    • Increase time for staff to enter results of IGRA

      • No Lab Interface System with lab

      • Two systems for compliance tracking

    • Increase time for clinician involvement

      • Signing visit notes

      • Signing lab results

      • Emailing lab results


    We also missed
    We also missed…

    • Who will contact student with the result

  • Increase time for staff to contact student with result

  • Increase paperwork time for staff

  • Short staff during PPD parties

  • Communication with the IGRA processing company for more boxes


  • Challenges
    Challenges

    • The T-Spot lab is in Boston

      • All test have to be complete by 3pm to be ready for shipping by 4pm

    • Bad weather can affect if samples get to the lab

      • Oxford Immunotec will be adding a site in Tennessee to decrease shipping time in January

    • Staff sick time/ vacation/ disability


    More challenges
    More Challenges

    • Student and Departments confusion

      • Not sure if this test will be accepted by rotations

    • Students and staff not aware of policy change

      • Not all students read the emails or newsletters

    • Staff in clinic not use to that pace of work


    The challenges continue
    The challenges continue

    • Decrease availability of clinician visits

    • Multiple tests to be done for Invalid or Borderline results


    Remote igra testing trial
    Remote IGRA testing trial

    PRO’s

    Con’s

    Difficult transporting of equipment and supplies

    Need more staff at event

    Leaves clinic short staffed for a greater amount of time

    Decreases amount of Primary Care visits available

    • Students appreciated having the choice

    • Had large turn out of students at one time

    • Decreased the amount of students in the SHC

    • Students educated on IGRA testing

    • Good Customer Service to students who are mandated to get the IGRA


    What will we do different next year
    What will we do different next year?

    • Give each school their own month to get the testing done

    • Build into schedule processing and paperwork time

    • Hire temp staff earlier for better training

    • Hire more temp staff for Remote PPD parties


    We will also
    We will also…

    • Coordinate with IGRA lab for more supplies

    • Inform students of IGRA testing and process at new student orientation

    • Remote IGRA testing???


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