Office of Epidemiology and Environmental Health Division Align Priorities -leading to a 50% reduction in time

Summary

Impact Statement:

Fast and effective investigations into foodborne illness outbreaks are an important part of a food safety program because they reduce the time that people are exposed to a pathogen. Toledo-Lucas County reduced the cycle time for an effective investigation and closure of foodborne outbreak cases from 44 to 22 days-- a 50% reduction!

Summary:

The Toledo–Lucas County Health Department (TLCHD) focused its quality improvement (QI) efforts on improving coordination, communication, and the time of completion of outbreak cases. A mean of 44 days was the average open-to-close time for cases of foodborne outbreaks from January 2009 to October 2011. The TLCHD team believes the ability to fine-tune and improve foodborne outbreak procedures will enhance coordination between epidemiologists, registered sanitarians, and their intended targets and partners. Improvement of procedures and coordination will enable TLCHD to ensure the most efficient and effective response to foodborne outbreak cases. After it completed this QI project, TLCHD lowered its open-to-close mean time for foodborne outbreak cases from 44 days to 22 days—a 50% reduction.

Improvement was measured by obtaining data from foodborne outbreak reports via TLCHD epidemiologists. Specifically, mean days per case were calculated from the “date created” and “close date” portions of the foodborne outbreak reports.

Organization that conducted the QI initiative:

Toledo–Lucas County Health Department

Citation:

Zgodzinski, E. Public Health Quality Improvement Exchange. Office of Epidemiology and Environmental Health Division Align Priorities -leading to a 50% reduction in time. Wed, 10/09/2013 - 12:55. Available at https://phqix.org/content/office-epidemiology-and-environmental-health-division-align-priorities-leading-50-reduction. Accessed May 28, 2023.

Background and Aim

Aim statement:

Between May 1 and November 30, 2012, the mean open-to-close time for foodborne response cases will decrease from an average of 44 days to 37 days, a reduction of 7 days (15%) when compared with foodborne cases from January 2009 to October 2011.

Need For The QI Initiative:

All operations within public health environments, including procedures and protocol, should be consistently reviewed, analyzed, and improved upon where necessary. Stagnant procedures that do not self-critique and implement best practices are not achieving their greatest potential.

Area for Improvement:

Public health surveillance is an imperative component to a food safety program. Lucas County has more than 3,500 food establishments. There were 21 total outbreaks reported in Lucas County in 2012 and 13 were thought to be potentially foodborne. Quality surveillance between registered sanitarians and epidemiologists allows public health officials to identify foodborne disease and behavioral trends. Multiple surveillance systems and methods are used to efficiently detect foodborne diseases. Complaints from consumers about potential illness and notifiable diseases, a strong foundation built around effective protocol, and fluid communication are imperative to quality surveillance. During all phases of foodborne investigation, coordination is essential. A clear, concise communication plan should be established, rehearsed, and well understood not only among the foodborne disease team members, but also with key external individuals within the community. Strong communication can lead to a better coordinated approach, which is important to all foodborne outbreaks. The coordination among agencies, local/state/federal authorities, local organizations, health care providers, the public, and the media will make a response more efficient. An efficient outbreak investigation reduces the time that people are exposed to a pathogen.

Root Cause:

TLCHD decided that the root cause was not having an updated interview form with all the needed information for the investigation. Further analysis showed that training was also needed on how to fill the form out properly.

Planning and Execution Details

QI Implementation:

The TLCHD Continuous Quality Improvement (CQI) team initially had the following five members: Patricia Fraker: Epidemiologist Tanika Carter: Epidemiologist Karim Baroudi: Environmental Health Supervisor Drew Downing: Advanced Practice Center (APC) Project Lead Greg Moore: APC Project Coordinator As the project progressed, Drew Downing accepted a position at Columbus Public Health Department, and Karim Baroudi accepted a position at the Ohio Department of Health. The following members were added to the team: Jerry Bingham: New Environmental Health Supervisor Additional people exposed to the initiative were as follows: Roberta Vasquez: Environmental Health Clerk Kelly Granger: Environmental Health Clerk Kelly Erret: Environmental Health Clerk TLCHD chose to focus its CQI efforts on maximizing efficiency in foodborne outbreak investigations. The Public Health Emergency Preparedness (PHEP) grant requires foodborne outbreak cases to be closed within 60 days. TLCHD, at the beginning of the project, was averaging 44 days open-to-close time for its foodborne outbreak investigations. The registered sanitarians and epidemiologists are lead investigators on foodborne outbreak cases and have recently been housed under the same department to better serve its customers. TLCHD thought that the mean close time of foodborne outbreak cases could be lowered by improving the efficiency of the department. Improving the department's efficiency would help to identify potential health problems and environmental public health hazards in a more timely manner, which could ultimately save lives. 1. Selected team members and assigned roles. 2. Clarified goal. 3. Created team charter, aim statement, flowchart, and fishbone diagram. 4. Brainstormed solutions based off the root cause analysis/fishbone diagram. TLCHD implemented the solution that was agreed on for the CQI project. The solution incorporated standardizing and updating the initial interview form “green sheet” and training environmental health clerk staff on the new form. The group decided that at least one epidemiologist should attend the weekly food service sanitarian meeting to foster communication between the two groups because the fishbone diagram showed this was one of the problems—communication between the sanitarian and epidemiologist. TLCHD decided that the root cause was not having an updated interview form with all the needed information for the investigation. Further analysis showed that training was also needed on how to fill the form out properly. 1. Interview form “green sheet” updated. 2. Training for environmental health staff was conducted. 3. Epidemiologists currently attend weekly food service meetings to foster communication.

Focus activities

Data collection, Epidemiology and Surveillance:

Communicable/infection diseases

Environmental health

Foodborne illness

Reportable diseases

Regulation, inspection and/or licensing :

Food service establishments

Other Environmental Health Services:

Food borne illness investigation

QI Methods:

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

Brainstorming

Fishbone Diagram

Flow chart

QI Tool Documentation:

DataAnalysis.xlsx

Fishbone.pdf

FlowChart.pdf

Improvement Hypothesis.docx

TeamCharter.pdf

Agendas.pdf

Agendas1.pdf

Green Sheet Original.docx

Green SheetRevised.docx

Initiative Dates:

12/17/12

Initiative Duration:

Between 6-12 months

Methods of evaluation:

Improvement was measured by obtaining data from foodborne outbreak reports via the TLCHD epidemiologists. Specifically, mean days per case will be calculated from the “date created” and “close date” portions of the foodborne outbreak reports.

Other Information:

Initially, TLCHD had a supervisor from environmental health on the CQI team. One of the lessons learned in the process showed that TLCHD should have included a clerk and a sanitarian on the team to foster communication to the group. This issue was evident when some sanitarians and clerks had a difficult time understanding the findings because the team relied on the supervisor to relay the project and action items to his employees. This issue also ensures buy-in of the CQI process if all disciplines are represented.

Office of Epidemiology and Environmental Health Division Align Priorities -leading to a 50% reduction in time

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

This was a great project that

QI Spotlight

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Office of Epidemiology and Environmental Health Division Align Priorities -leading to a 50% reduction in time

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

QI Spotlight