Environmental Impact and Provider Satisfaction Associated with ePrescriptions in Otolaryngology: A Quality Improvement Study

Abstract

ImportanceePrescriptions are associated with increased patient satisfaction, decreased provider burden, decreased administrative costs, and a positive impact on planetary health. However, ePrescription uptake by physicians is historically low and acts as a barrier to reaping the benefits therein.ObjectiveWe aimed to attain 20% overall usage of ePrescriptions in the Department of Otolaryngology-Head and Neck Surgery (OHNS) at the London Health Sciences Centre (LHSC) by December 2023 through systematic implementation of change ideas.DesignPre-post intervention design.SettingAmbulatory clinics in OHNS at LHSC, an academic hospital.ParticipantsFourteen staff and 15 resident physicians in OHNS; 38 patients in pediatric otolaryngology clinic.Intervention or ExposureA root-cause analysis identified potential obstacles to ePrescribing. Change ideas, including educational seminars, surveys, quarterly reporting of ePrescription usage, and public encouragement of top ePrescribers in the department, were implemented and tested using Plan-Do-Study-Act cycles.Main Outcome MeasuresPercent ePrescription usage and carbon footprint savings associated with ePrescriptions were measured. Provider and patient satisfaction surveys were conducted as balancing measures to assess for the perception of increased burden on providers.ResultsDuring the pre-intervention and post-intervention phases, a total of 400 and 1000 ePrescriptions were prescribed by the department, respectively. There was a statistically-significant increase in the mean proportion of ePrescriptions used before (mean: 9.7%; sd = 7.6) and after (mean: 40.7%; sd = 6.4) the intervention (p < 0.001), which exceeded the goal. SPC charting suggested special cause variation, signifying a statistically-significant improvement. Additionally, a reduction of 125.9 lbs of CO₂ equivalents was associated with ePrescription use. 66.7% of providers rated overall satisfaction with ePrescriptions at 7/10 or higher, and 76.9% indicated that patients either sometimes, usually, or always opted for ePrescriptions when given the choice.Conclusion and RelevantOur change ideas increased ePrescription usage in an academic OHNS department and were associated with increased planetary health savings and provider satisfaction.

Keywords: ePrescriptions; environmental sustainability; otolaryngology; quality improvement.

Graphical Abstract

Figure 1.

Statistical process control charts, which show special cause variation after the implementation of the change ideas (arrow), which signifies a statistically-significant improvement in all graphs. (A) The proportion of ePrescriptions sent from ambulatory clinics in OHNS over the study period across the entire department. (B) The proportion of ePrescriptions sent from ambulatory clinics in Pediatric OHNS over the study period. (C) The proportion of ePrescriptions sent from ambulatory clinics in Head and Neck OHNS over the study period. (D) The proportion of ePrescriptions sent from ambulatory clinics in Otology/Neurotology OHNS over the study period. The blue arrow represents the onset of change idea implementation.

Figure 2.

(A) The provider overall satisfaction ratings with the ePrescription system (0 = low satisfaction; 10 = high satisfaction). (B) The provider reporting of how often patients opt for ePrescription options. (C) The preferred method of prescribing for providers before and after interventions.

Appendix 1.

Ishikawa diagram for root-cause analysis of the possible causes for low ePrescription usage prior to implementation of intervention.