Enhancing Stool Sample Collection in an Urban Gastroenterology Clinic: A Quality Improvement Project

Accurate stool sample collection is pivotal for diagnosing gastrointestinal conditions, offering a less-invasive and cost-effective alternative to endoscopic procedures. Research emphasizes that educating patients on accurate storage, transportation, and timing for stool specimens is crucial to ensure precise test outcomes. Additionally, suboptimal collection methods can lead to diagnostic delays, erroneous results, poor patient outcomes, and increased healthcare costs. Local Problem: Due to notable errors, the Sugarhouse and Redwood Gastroenterology Clinics within the University of Utah (UofU) healthcare organization needed a standardized outpatient stool collection process. Issues included the distribution of incorrect test vials and inaccurate storage instructions on patient education materials, potentially compromising test accuracy, leading to rejected stool specimens and delays in diagnosing and treating GI disorders. Methods: The Johns Hopkins Nursing Evidenced-based Practice (JHEBP) model identified barriers and limitations in the current stool collection process. This model provided a structured framework for conducting quality improvement projects in healthcare, allowing for a comprehensive assessment, critical appraisal of evidence, and integration of evidence-based practices with clinical expertise for positive healthcare outcomes. Interventions: A literature review and pre-survey identified errors, guiding the development of a new workflow and refined patient education in collaboration with key healthcare partners. Instructional videos and QR-coded resources were created and distributed. Educational resources synthesized and disseminated best practices to staff. One champion was designated at each clinic to ensure effective implementation and sustainability. A follow-up survey assessed staff satisfaction and perceived barriers, informing healthcare partners in an executive summary. Results: GI staff reported a 30% familiarity pre-intervention, increasing to 78% post-intervention. Formal training increased by 60% post-intervention compared to none initially (p < .01). Post-intervention, 60% perceived communication and collaboration among staff as highly effective. Common themes included insufficient training, lack of clear guidelines, and inadequate communication, with increased numbers of staff feeling these barriers were addressed by this DNP project. Conclusion: This DNP project aimed to enhance stool sample collection processes in two outpatient urban GI clinics. Based on research findings, it implemented a standardized workflow, increased staff training, and enhanced patient education. The focus was on improving pre-analytical stool sample preservation methods to improve accuracy and consistency in sample collection. This optimization supports better patient care by facilitating the detection of biomarkers crucial for diagnosing GI disorders, offering more efficient and cost-effective methods.