Workflow Improvement and the Use of PDSA Cycles: An Exploration Using Screening, Brief Intervention, and Referral to Treatment (SBIRT) Integration

Background and Objectives: The purpose of the study was to use a best practice quality improvement process to identify and eliminate barriers to Screening, Brief Intervention, and Referral to Treatment (SBIRT) integration in a Federally Qualified Health Center. SBIRT provides an initial method for addressing mental health and substance abuse concerns of patients. The method is very useful in integration of behavioral health screening in primary care. Methods: A Process Improvement Team used 4 Plan-Do-Study-Act cycles during a 10-week time frame to (1) reduce the reported frequency of barriers to the SBIRT process, (2) reduce non-value-added activities in the SBIRT workflow, (3) reduce bottlenecks, and (4) increase patient receipt of SBIRT. A modified Referral Barriers Questionnaire, a swim lane diagram, non-value-added versus value-added analysis, and a Shewhart control chart (P-chart) were used to evaluate process and outcome measures. Results: Nurses reported a 23.82% reduction in referral barrier frequency and a 21.12% increase in the helpfulness of SBIRT. Providers reported a 7.60% reduction in referral barrier frequency and a decrease in the helpfulness of SBIRT. The P-chart indicated that the process changes resulted in a positive shift in behaviors and an increase in patient receipt of SBIRT. Conclusion: The use of a best practice quality improvement process resulted in improvements in workflow related to SBIRT, greater communication about SBIRT, and identification of barriers that blocked successful receipt of SBIRT.