The Implementation of Fecal Sample Collection Workflow: An Evidence-Based Practice Quality Improvement Project

Background: Stool sample collection represents a critical diagnostic tool for identifying gastrointestinal: disorders. However, family practice clinics serving refugee communities face unique challenges with incomplete stool samples due to language barriers, varying literacy levels, and cultural differences. These challenges may contribute to delayed diagnoses, repeated visits, and health inequities. At a family practice clinic serving a diverse refugee population, patients were experiencing difficulties completing stool collections due to inadequate multilingual instructions, while staff lacked standardized workflow protocols. This quality improvement project addressed these challenges by implementing standardized processes and developing culturally appropriate patient education materials. Methods: This three-month evidence-based quality improvement project utilized the Johns Hopkins Nursing Evidence-Based Practice Model and Plan-Do-Study-Act cycles. Interventions included (1) developing a standardized workflow protocol for clinic staff through comprehensive training sessions and quick reference materials; (2) creating simplified, multilingual patient education materials in English, Spanish, and Arabic; and (3) producing a wordless instructional video accessible via QR code to overcome language and literacy barriers. Pre- and postimplementation surveys (N=17, N=14) measured staff knowledge and confidence regarding stool collection procedures. Qualitative data analysis identified key themes in staff feedback. Chart reviews assessed specimen completion rates before (N=7) and after (N=11) implementation. Results: Statistically significant improvements were observed in staff confidence across all communication contexts (p<0.05), particularly with non-English speaking patients (W=165, p=0.048) and those with low literacy (W=167, p=0.043). Knowledge of test-specific requirements improved, with the greatest gains in FOBT sample requirements (23.53% to 64.29%, p=0.021). Staff reported high satisfaction with the new process (92.86%), particularly valuing quick reference materials and visual aids. Qualitative feedback revealed that visual aids and clear, simplified instructions were most beneficial for patient education. Ova and parasite specimen completion rates increased from 42.86% to 54.55% for one or more specimens, with full three-specimen completion rates rising substantially from 14.29% to 36.36%. The instructional video was viewed 39 times during the implementation period. Conclusions: This quality improvement initiative demonstrated that addressing social determinants of health through tailored educational approaches can significantly improve diagnostic testing compliance in diverse patient populations. The comprehensive approach of standardizing workflows while enhancing patient education materials effectively overcame language and literacy barriers. The statistically significant improvements in staff confidence across communication contexts and increased specimen completion rates suggest that the dual focus on staff training and patient education materials can successfully reduce health inequities in diagnostic testing. These findings highlight the importance of culturally sensitive, accessible healthcare communication in promoting equitable healthcare delivery. Future investigations should explore additional barriers beyond knowledge deficits and evaluate the economic impact of enhanced educational materials versus reduced repeated testing in diverse healthcare settings.