Medicine and Health Sciences Commons^™

Jefferson Internal Medicine Associates (Jima) Patient Triage Initiative, Mary White, Alexandra Leto, Barry Ziring, Md

Health Equity and Quality Improvement (HEQI) Summit

HOW MIGHT WE:

1. Contact patients to triage them for in-person versus virtual visits and teach them to use telehealth quickly?
2. How might we screen patients who are coming to the office for COVID-19 symptoms and exposures?

Safer Ambu-Bag Manual Ventilation Through Addition Of A Second High Efficiency Particulate Air (Hepa) Filter, Robert Ries, Morgan Hutchinson, Md, Robert Pugliese, Pharmd, Bon Ku, Md, Mpp, Matt Fields, Md

Health Equity and Quality Improvement (HEQI) Summit

• Experts from the Thomas Jefferson University Health Design Lab met with Emergency Medicine and Anesthesia physicians and local engineers
• A design was envisioned in which 3-D printed connectors could be created to add an additional HEPA Filter as shown in Figure 1
• STL Files for the adapters were created based on standard HEPA filter diameters and 3-D printed
• The second HEPA filter was easily assembled by novice users using the adapters
• Ventilation adequacy using the double HEPA filter ambu-bag was similar to single HEPA filtered ambu-bag ventilation based on observed inflation of a test lung

Intelligence Reporting In The Face Of Covid-19: Informing Our Response Efforts, Jamie D. Garden

Health Equity and Quality Improvement (HEQI) Summit

How might we provide successful intelligence?

1. Gather all relevant information from all possible sources available (academia, news, social media, human intelligence, etc.)
2. Sort intelligence based on relevance and credibility.
3. Identify trends, indicators, vulnerabilities, and warnings.
4. Assess opportunity analysis.

The Tjuh Hospital Medicine Covid19 Emergency Taskforce: A Guiding Light During The Surge Of Spring 2020, Rebecca Jaffe, Md, Alan Kubey, Md, Gretchen Diemer, Md, Michele Decastro, Lily Ackermann, Md, Christopher Haines, Md, Jesse Edwards, Md, René Daniel, Catriona Harrop, Md, Jonathan Woo, Md, Jack Stewart, Md

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

In mid March 2020 a highly infectious and deadly disease appeared in Philadelphia that no American physician had ever treated before. The challenge of disseminating reliable and relevant information about a novel and dangerous pathogen across practice areas cannot be understated.

Usual practices for communication and leadership are not designed to manage this kind of challenge.

A Web-Based Application To Simulate Manual Bag-Valve-Tube Ventilation, Robert Ries, Erin Jennings, Dylan Kenna, Logan May, Robert Pugliese, Pharmd, Matt Fields, Md

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

• The COVID-19 pandemic has threatened ventilator capacity in many locations which has led to alternative solutions to meet surge ventilator capacity including a strategy for deploying large-scale volunteer continuous bag-valve-tube (BVT) ventilation
• While an online training module may teach the manual ventilation volunteer force requisite knowledge, evidence suggests technology enhanced simulation training in health professions training is associated with improved outcomes for desired knowledge, skills and behaviors

Qr-Code Based Just-In-Time Platform For Perioperative Covid Guidelines, David F. Nelson, Md, Mba, Anna L. Rabinowitz, Md

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

When the COVID-19 Pandemic arrived in Philadelphia in March 2020, leadership at Thomas Jefferson University Hospital began a process of quickly authoring and updating a multitude of clinical guidelines, PPE (personal protective equipment) usage protocols, and surgical care standards in rapid succession.

The scope and scale of perioperative care at TJUH, which is made up of the Departments of Anesthesiology, Surgery, and Perioperative Nursing, means that a large and diverse number of individuals need timely access to a curated collection of resources that are specifically relevant to emergency airway management, urgent surgical care, testing, and recovery.

Large …

Maintaining Powered Air-Purifying Respirator (Papr) Supply Through Repair Of Damaged Hose Units By 3d Printing, Dante Varotsis, Robert Ries, Michelle Ho, Kathryn Linder, Jordan Kurzum, Robert Pugliese, Pharmd, Bon Ku, Md, Mpp, Matt Fields, Md, Morgan Hutchinson, Md

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

• Powered air-purifying respirators (PAPRs) are a type of Personal Protective Equipment (PPE) that serves an essential line of defense against the spread of COVID-19 and other airborne pathogens.
• Demand for PAPRs are at a premium during a time where supply chains have been disrupted.
• The hose component of the 3M™ Air-Mate™ PAPR has a fragile interface with the hood, leading to damage and rendering the PAPR unit unsafe for continued use.
• PAPR units are on backorder, as are their components.
• Given the acute need for functional PAPRs other approaches for repair were explored.

Home Telemonitoring Of Covid Patients By Medical Students At The Christiana Care Virtual Practice, Thomas Marconi, Jr, Chelsea Richards

Health Equity and Quality Improvement (HEQI) Summit

SARS-Cov2 arrived in Delaware on March 11, 2020. By March 22, 2020, stay at home orders were in place1. During this time, CareVio, a subsidiary of ChristianaCare, was tasked with developing a strategy to monitor the Delaware community. CareVio repurposed Twistle – a telemonitoring application utilized to distribute symptom related surveys and conduct text message conversations for follow up. This service had the capability to act as a virtual information desk and triage patients to be seen by virtual practice providers or the emergency department. Patient monitoring via Twistle was initiated on March 18, 2020 and medical students from Sidney …

A Telehealth Clinical Workflow For Academic Radiation Oncology Programs During The Covid19 Pandemic, Gregor Manukian, Md, Phd, Christian Fernandez, Md, Paul Forrest, Adam Dicker, Md, Phd, Mark D. Hurwitz, Md

Health Equity and Quality Improvement (HEQI) Summit

• COVID19 has resulted in drastic measures to decrease exposure risks within healthcare systems, with cancer patients at increased risk of infection and death (Liang. Lancet Oncol. 2020).
• Telehealth is the delivery of medical care via interactive audio and/or video telecommunication services.
• Telehealth was previously used sparingly within the department of radiation oncology but has suddenly become the preferred method of contact.
• In order to maintain quality of care, patient satisfaction, resident learning, and reimbursement, a robust telehealth clinical workflow is critical.
• Our department engaged various stakeholder to quickly develop a clinical workflow.

Initiatives In Anesthesia Workspace Hygiene During Covid-19: The Gray Airway Basin And The Epic Hand Hygiene Event, Anna Rabinowitz, Kent Berg, Daniel Casey, Dietrich Gravenstein

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

The COVID-19 Pandemic has highlighted the need for anesthesia providers to decrease workspace contamination, particularly during and after airway management.

Delineation of “clean” and “dirty” spaces in the anesthesia workplace has been historically challenging, but the heightened awareness of microbial contamination presents a new opportunity to effect behavioral change among staff.

Irradiation Of N95 Masks For Their Sterilization And Reuse During The Covid19 Pandemic, Tara Tyson, Phd, Alex Kubli, Ms, Matthew Mistro, Ms, Karen Mooney, Phd, Amy Harrison, Phd, Adam Dicker, Md, Phd

Health Equity and Quality Improvement (HEQI) Summit

Research Objective

We sought to investigate the feasibility of irradiation for N95 mask sterilization.

Anesthesiologist-Led Covid-19 Airway Training Skills Session To Teach Novel Team Approach And Workflow, Anna Rabinowitz, Daniel Casey, Elaine Kilmartin

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

Intubation is an aerosol-generating procedure that poses a significant infectious risk to the operator in the COVID-19 era, where the volume of intubations was expected to increase dramatically. Following national anesthesia societal and organizational recommendations regarding best practices to decrease risk of viral transmission, a new 3-person airway team approach was developed. Additions to the preexisting airway management workflow included an aerosol-containing intubation shield, a new breathing circuit configuration incorporating HEPA filtration, and the use of unfamiliar PPE, all of which required mastery of a complex sequence of events surrounding the patient encounter. This high-stakes workflow was …

A Strategy For Deploying Large-Scale Volunteer Continuous Bag Valve Tube (Bvt) Ventilation, Robert Ries, Erin Jennings, Michael Velez, Caroline Komlo, Morgan Hutchinson, Md, Robert Pugliese, Pharmd, Bon Ku, Md, Mpp, Matt Fields, Md

Health Equity and Quality Improvement (HEQI) Summit

Part 1: Hospital Guide

The hospital guide outlines steps and considerations for the healthcare system to successfully implement a manual ventilation strategy

Part 2: Online BVT Training Module

We created an online articulate evidence based training module for safe and effective Bag-Valve-Tube (BVT) ventilation for medical and nonmedical providers.

Nursing And Provider Safety Checklist For Covid-19 Patients, Michele Decastro, Msn, Crnp, Jennifer Zak, Bs, Rn, Pccn, Andrew Thum, Msn, Ml, Rn-Cc, Ccctm, Kristine Meagher, Rn, Msn, Acns-Bc

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

As increasing numbers of Covid-19 patients were admitted to the hospital, multiple Med-Surg and Telemetry units were needed to provide care. All healthcare providers noted difficulty in communicating patient plans of care across multiple units and multiple teams. Providers, Clinical Nurses, and Nursing leadership all noted differences in processes for care and communication among units and teams.

Covid: Decoded - A Website, Blog, And Social Media Page With Resources And Information For The Public, Jessica Smith, Taylor Jones, Madeline Norris, Benjamin Meyers, Christopher Haines, Md

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

Information about COVID19 in the news and on social media platforms is overwhelming, confusing, riddled with jargon and sometimes straight up wrong. Makig it easy for the public to misinterpret facts or simply accept headlines and infographics at facevalue without checking with primary and/or reputable sources.

The nature of social media also allows for a perpetuation of this misinformation without recourse. Recall the one article floating around Facebook reporting that gargling salt/vinegar water could help prevent COVID19. We needede a source of simplified, reliable information about the pandemic for people outside of the health professions.

Medical students …

Expansion And Conversion Of Family Medicine And Neurohospitalist Services Into Covid-19 Services, Zachary Klock, Md, Aimee Mcmullin, Md, Jesse Edwards, Md, Christopher Haines, Md

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

• During the COVID-19 pandemic, there was an anticipated increase in the number of patients admitted with COVID-19.
• To meet the increased number of admitted patients, additional providers and teams were needed to care for hospitalized patients during the pandemic.
• Pre-existing teams needed to find ways to expand (in the case of the Family Medicine service) and repurpose (in the case of the Neurohospitalist service) in order to care for an increased number of patients.

Virtual Community Health Workers: Outreach Calls During Covid-19, Geoffrey Hayden, Md, Paula Ostroff, Rn, Ms, Emily Romano, Bs, Imani Gray-Taylor, Carl Johnson, Bs, Angelique Miller, Sharla Thomas, Ba, Gina Mccoy, Bs, Deborah Ziring, Md

Health Equity and Quality Improvement (HEQI) Summit

The “Clinical Experience” program at the Sidney Kimmel Medical College, established in 2017, provides pre-clerkship students with an opportunity to identify and address patients’ needs for social determinants of health (SDoH). The COVID-19 pandemic led to a suspension of the student program in the clinical environment, but the CHWs continued to address patients’ social needs from a remote setting. In the absence of established best practices regarding patient outreach calls from a remote setting, we sought to develop an effective workflow that would mask the CHWs’ personal cell phones while leading to fewer “unable to reach” scenarios and improved case …

Development And Implementation Of A Covid-19 Specific Peri-Operative Workflow For Anesthesia Providers, Alexander Olson, David Maguire, David Gratch, Dietrich Gravenstein, Michael Mahla, Anna Rabinowitz

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

• Needed to develop and clarify the use of PPE in the COVID-19 era
• New considerations for infection control in OR
• Unique airway equipment and filter placement considerations
• Potential shortages of equipment and medications, need for conservation
• Need to incorporate human factors principles into protocol release and procedural compliance

We realized that there was no standard protocol for these functions existing in a visually compelling graphic form for wide distribution throughout anesthesia care areas, and sought to create one.

Avoid, Delay, Shorten. Results Of Radiation Oncology’S Covid19 Patient Exposure Risk Mitigation Guidelines, Alex Kubli, Ms, Lilya Babinski, Bs, Angelia Landers, Phd, Christian Fernandez, Md, Amy Harrison, Phd

Health Equity and Quality Improvement (HEQI) Summit

We implemented evidence-based COVID19 guidelines on 3/16/20 to minimize patient exposure risks by avoiding, delaying, and shortening patient treatments when possible.

We analyzed the effectiveness of our COVID guidelines by comparing the number of new patient starts and number of treatments before and after implementation.

Our department successfully decreased patient exposure risk by reducing new prescription starts, rates of longer treatment courses, and overall number of treatment encounters in an evidence-based approach.

Expanding Care Coordination Scope To Support Covid-19 Population, Kate Behan, Cpho, Laura Gontz, Rn, Shawn Thurber, Rn, Christin Kyriss, Rn

Health Equity and Quality Improvement (HEQI) Summit

Covid-19 has caused overwhelming surges of cases in urban areas across the world. To assist with difficult discharges, as well as avoid unnecessary readmissions and ED visits, the care coordination team has created a comprehensive follow up care pathway across the enterprise to support our COVID-19 patients. This care pathway looks to assist Covid patients by reinforcing self-care management, providing education and supporting adherence with scheduled follow up with a primary care provider.

Technology was leveraged to interact virtually with patients who are quarantined at home. Jefferson Abington and Jefferson Northeast partnered with DinaCare to utilize their texting platform to …

Sars-Cov-2 Testing Guidelines For Patients Admitted To Mrh For Inpatient Rehabilitation, Deborah Cassidy, Do, Roger Liu, Do, Malav Shah, Md, Kyle Hummerston, Do, Jeanne Doherty, Md

Health Equity and Quality Improvement (HEQI) Summit

We implemented a clinical algorithmic approach with an emphasis on symptoms and risk to stratify patients into 3 groups:

• Acutely Ill COVID Rule Out/PUI
• Stable COVID Rule Out/PUI
• COVID OBS

Scrubs Tracking, Michael Saris

Health Equity and Quality Improvement (HEQI) Summit

The DICE Group repurposed an ID badge scanning app originally built for OIA to enable scrubs to be checked out then checked back in, therefore enforcing rationing limits.

John Covid-19 Employee Exposure Tracking, Michael Saris

Health Equity and Quality Improvement (HEQI) Summit

We iteratively built a data entry and dashboarding platform that has enabled JOHN to track over 2,500 employees exposed to COVID-19 or at high risk of exposure to COVID-19.

Covid-19 Student Telehealth Support Initiative, Yash Varma, Mary White, Alexandra Leto

Health Equity and Quality Improvement (HEQI) Summit

SKMC students partnered with numerous TJUH departments and developed a telehealth support initiative to:

• Help TJUH patients navigate the telehealth system
• Reduce system-wide appointment delays experienced by patients
• Provide direction to COVID-19 resources

A Volunteer Script was prepared to help patients troubleshoot common issues with accessing the telehealth system and provide up to date recommendations from the CDC to remain safe.

Twilighter Role To Support Primary Team Patient Care, Workflow Efficiency, And Physician Wellbeing, Jesse Edwards, René Daniel, Catriona Harrop

Health Equity and Quality Improvement (HEQI) Summit

Objective

Enhance patient care, process efficiency, and physician wellbeing by decompressing primary team workload and reducing the multitasking demands during critical hours of the daily workflow

Ventilator Decision And Allocation Pathway For Surge Conditions, Bridget Gekas, Jerin Juby, Monica Purcell, John Smith, Laura Fantazzi, Raymond Malloy

Health Equity and Quality Improvement (HEQI) Summit

We created a deployment plan of the available ventilator fleet to be deployed during surge conditions. The plan includes appropriate allocation of acute care ventilators to manage complex respiratory patients, while a percentage of stable respiratory patients can be safely managed using a back-up ventilator.

Organizing A System-Wide Effort On Ventilator Supply Management During Covid-19, Jerin Juby, Raymond Malloy, Bridget Gekas, Laura Fantazzi, Monica Purcell, John Smith, Kathryn Sebastian, Lauren Diduch, Melissa Brancolassi, Megan Hennessy, James Fields

Health Equity and Quality Improvement (HEQI) Summit

We developed a concise definition of ventilators to accurately represent them in all reports across the enterprise, and a ventilator deployment plan.

Use Of Mobility And Exercise Videos During Covid-19 To Minimize Deconditioning, Nethra Ankam, Md, Tulasi Gude, Md, Courtney Back, Pt, Monina Florendo, Pt, Elizabeth Hearn, Pt, Morgan Miller, Pt, Kristen Stout, Pt

Health Equity and Quality Improvement (HEQI) Summit

COVID19 patients are at risk for becoming quickly deconditioned, especially in the hospital setting given the nature of the virus and those that get admitted. The concern for deconditioning stems from patients being confined to their room, the need to minimize exposure amongst healthcare providers and the need to conserve PPE.

We wanted to find ways to optimize opportunities for patient mobility, maintain patient and provider safety, all while conserving PPE. We reviewed the Chinese Association of Rehabilitation Medicine guidelines to help develop the exercise program.

Meeting The Critical Need For Ventilators In Treatment Of Covid-19 Patients, Alessandro Naopli, Nicholas Satterthwaite, Lawrence Husick, Dietrich Gravenstein, Jerin Juby, Monica Purcell, Bridget Gekas, Zvi Grunwald, Mae West, Bon Ku, Chip Malloy, Michael Mahla, Mijail Serruya

Health Equity and Quality Improvement (HEQI) Summit

We have designed and built a microprocessor-controlled valve manifold having a single air input supplied from a standard ventilator, three air outlets (one per patient), and a digital control panel for setting the pressure supplied to each patient as well as the desired respiration rate. The manifold features multiple pressure sensors for system monitoring. Each inspiration limb of the manifold will be fitted with a viral filter. Each expiration limb will have a passive HME in line with a viral filter to prevent patient cross-contamination and spread of virions.

Each patient will receive one epoch of inspiration pressure followed by …

#Team-Based Approach To Sedation Management In Patients With Sars Cov-2 Aka Covid-19 In The Medical Icu, Hadiatou Barry, Md, Mph, Franklin Thelmo, Do, Atsoufi Amewuame-Kpehor, Md

Health Equity and Quality Improvement (HEQI) Summit

The COVID-19 pandemic has led to a proliferation of patients developing ARDS and requiring prolonged supportive care on mechanical ventilation. As a result, patients need elevated levels of sedation, often on multiple agents for a period greater than typically seen in an ICU population. As a result of this high sedation phenomenon, patients are developing higher rates of expected complications including severe constipation, neurocognitive delay, ICU myopathy, poor sedation weaning, and high pain control requirements. These complications lead to an increased rate of mortality in a population that is already very high and decreases the rate of successful extubation and …