Background/Purpose: Gout is a chronic, but treatable, inflammatory disease characterized by intermittent flares involving the deposition of monosodium urate crystals in and around joints. It affects 41 million adults worldwide, with a prevalence of 3-6% in men and 1-3% in women. There was a recent increase in the incidence of ER visits and hospitalizations for gout flares. A diet high in purines increases the risk of an acute gout attack by approximately 5-fold and may exacerbate an ongoing flare. ACR 2020 conditionally recommends limiting purine intake regardless of disease activity. The goal of this project was to first assess via surveys, and then improve with an educational campaign, resident physician knowledge on placing purine-restricted diet orders in the electronic medical record (EMR) for patients admitted to our facility with a diagnosis of gout.

Methods: Internal Medicine residents were asked to complete a brief online survey to determine their knowledge of ordering a purine-restricted diet for patients with gout both before and eight weeks after the initiation of the educational intervention. The intervention consisted of interactive educational lectures on how to place purine-restricted orders in the EMR, one-on-one education, and reminders by an infographic posted in the resident lounge.

Results: Fifty Internal medicine residents had the opportunity to participate, with 48 pre-intervention and 49 post-intervention surveys collected. At baseline, 39.58% [95% CI 27.02, 53.69%] of the participating residents knew how to place a purine-restricted diet order; this improved to 100% [95% CI 92.73, 100%] post-intervention. Before the intervention, only 10.41% [95% CI 4.53, 22.17%] of residents always placed a purine-restricted diet for patients with gout, 37.5% [95% CI 25.22, 51.64%] sometimes did, and 52.01% [95% CI 38.33, 65.53%] never did. After the intervention, these numbers improved to 51.02% [95% CI 37.47, 64.42%] always placing a purine-restricted diet, 24.48% [95% CI 14.60, 38.09%] sometimes placing the order, and 24.48% [95% CI 14.6, 38.09%] still never placing the order. Overall, 93.88% [95% CI 83.48, 97.90%] of the participants rated the project as helpful, while 6.1% [95%CI 2.10, 16.52%]rated it as neutral.

Conclusion: The majority of residents found this educational QI project helpful. Our study was limited by the anonymity of the surveys such that it is possible repeated responses may have occurred. Also, the number of gout patients encountered during the time frame of this study may have impacted the post-intervention survey responses about placing diet orders. Overall, our educational intervention increased resident awareness about the effects of a purine rich diet on gout flares and significantly increased their knowledge on how to place purine-restricted diet orders.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/educational-quality-improvement-qi-project-to-improve-inpatient-purine-restricted-diet-order-placement-for-patients-admitted-with-gout-flares/