Medicine and Health Sciences Commons^™

Improvement In Patient Safety Through “Irrigation Time-Outs” During Turp Procedures, B. L. Deiling, Do, E. Kilmartin, Md, T. L. Kennedy, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objective

During any surgical procedure, clear and standardized communication among surgeons, anesthesiologists and operating room nursing staff is a necessity for all aspects of patient safety. During TURP procedures, the perioperative staff must alert team members of the signs and predictors for the potential of TURP syndrome or NSS overload. The goal of our quality improvement project is to increase communication and diagnostic actions based on irrigation fluid amounts among surgeons, anesthesiologists, and the operating room nurses in order to decrease complications in TURP patients at Jefferson over the next six months.

Central Line Cart: An Emergency Department Initiative To Improve Efficiency, M. Ahmed, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

• Critically ill patients that present to the emergency room often require time sensitive resuscitative measures, which often necessitates placement of a central venous catheter.
• Efficient placement of a central venous catheter is often limited by the time it takes to gather the number of supplies needed for the task.
• It is already known that central venous catheter procedure carts and kits decrease the incidence of central line associated bloodstream infections (CLABSIs)1 as well as reduce the incidence of procedural mistakes during central line insertion2
• However, there is a paucity of data in regards to the impact of central line …

The ‘Med History Note’: A Standardized Method Of Reducing Medication History Errors Among Internal Medicine Residents In A Teaching Hospital, Odunayo Banjoko, Md, Babatunde Ogunnaike, Md, Genene Amoia-Pigliacelli, Pharmd, Doron Schneider, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Problem Statement

According to the institute of medicine’s preventing medication errors report, the average hospitalized patient is subject to at least one medication error per day. Errors have been known to occur during admission, transfer and discharge of patients. An accurate medication history on admission is crucial and can go a long way in preventing medication reconciliation errors. Of note, more than 40% of medication errors occur from inadequate reconciliation, during admission, transfer and discharge of patients. Of these, 20% result in harm.

Implementation Of Attending-Supervised Ipass Handoff In The Neuro-Icu, Laura Cifrese, Md, Sonia Gill, Md, Megan Margiotta, Md, Muhammad Athar, Md, Rodney Bell, Md, Sara Hefton, Md, Fred Rincon, Md, Msc, Mbe, Syed Shah, Md, Mba, Jacqueline Urtecho, Md, Matthew Vibbert, Md, David Wyler, Md, Amandeep Dolla, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

• Duty hour restrictions, cross coverage, and the growing number of mid-level practitioners has led to an increased number of handoffs across medical specialties
• These handoffs are well-known points of communication breakdown which can lead to patient safety issues
• Factors contributing to an effective handoff include standardization of communication, appropriate training and supervision, ample time, a quiet environment, and a supportive culture
• We hypothesize that attending supervision of handoffs is feasible and can improve practitioner perception of transitions of care

Adequate Patient Education - The Key To Improving Patient Experience While Being Under Contact Precautions?, Edosio Eloho, Md, Mary Naglak, Phd, Doron Schneider, Md, Hadiatou Barry, Md, Babatunde Ogunnaike, Md, Puneet Dhillon, Md, Neethu Gopisetti, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

To improve patient satisfaction with the quality of education provided about CP by at least 30% by the end of 7 months. Through the provision of a standardized patient education sheet to hospitalized patients placed on CP within their first 24 hours being placed under contact isolation.

Order From Order Sets: Analysis Of Ordering Patterns And Patient Outcomes Before And After Order Set Changes On The Inpatient Psychiatry Units At Tjuh, David Halpern, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aims

Short Term

To decrease the total number of times one-time orders were added for patients for Vistaril, Remeron, Melatonin, Colace, Senna, and MiraLAX. Increase number of times urine PCP and urine oxycodone added to the urine drug screen.

Long Term

To decrease overall length of stay and improve treatment outcomes

Standardized Discharge Instructions And Their Impact On Post Operative Patient Knowledge, Nikolaus Hjelm, Md, Gregory Epps, Md, Ryan Rimmer, Md, Lauren Bogdan, Md, Erin Reilly, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

After every surgery, surgeons send their patients home with discharge instructions. The information is intended to educate the patients about their postoperative care and how to safely care for themselves upon returning home. Each surgeon reviews and approves the discharge instructions before they are given to their patients. This information is once again reviewed by the patient’s nurse before the patient leaves the hospital.

Within a large hospital, there are often several surgeons within each specialty that perform the same surgeries. The department of Otolaryngology at Thomas Jefferson University Hospital is no exception. Within otolaryngology there are several subspecialties. At …

Optimizing Physical Therapy Sessions Among Patients Undergoing Elective Lumbar Surgery, Ellina Hattar, Md, Kelly Hufford, Dpt, Marie Wilson, Rn, James Harrop

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

Physical therapy is imperative in achieving early mobilization, thereby reducing morbidity of immobility such as venous thrombolic events, improving postoperative pain, and facilitating appropriate disposition among patients who have recently undergone spine surgery. At TJUH, patients undergoing elective spine surgery are planned to engage in physical therapy (PT) twice a day. There are however several impediments that may limit the ability of patients to adequately participate in PT.

Improving Follow-Up For Family Medicine Patients After Hospital Discharge, Erica Li, Md, Rebecca Simon, Md, Michael Weissberger, Md, Angela Silverman, Md, Mpg, Bryan Botti, Md, Laura Emerson, Md, Zoe Agoos, Md, Rachel Ehrman-Dupre, Md, Jennifer Moyer, Md, Andrew Rabovsky, Md, Geoffrey Mills, Md, Phd

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aims

• Increase percentage of JFMA patients with follow-up appointment scheduled after discharge to 100% by March 2018
• Increase percentage of JFMA patients who show up to their follow up appointments after discharge to 80% by March 2018

Improving Resident Confidence And Efficiency During Stroke Alerts Through Simulation Training, Megan Margiotta, Md, Danielle Wilhour, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Maria Carissa Pineda, Md, Fred Rincon, Md, Rodney Bell, Md, Diana Tzeng, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

• Teach incoming neurology residents how to respond efficiently and appropriately to stroke alerts
• Improve the confidence level of residents during stroke alerts

A Provider-Based Survey On Quality Of Care And Identification Of Quality Gaps In Inpatient Palliative Care, Adam Pennarola, Md, Mph, Matthew Murphy, Md, Elizabeth Collins, Md, Beth Wagner, Msn, Crnp, Achpn, John Liantonio, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

Inpatient Palliative Care Teams (IPCTs) are often called upon to provide multidisciplinary care across hospital settings at Jefferson. However, there is currently no mechanism in place wherein providers consulting the IPCT can provide feedback to specialty palliative care clinicians. Such input from providers could be used to elucidate those services provided by the team which are most appreciated and those which require further development in order to be truly effective. Furthermore, such input may also serve to identify completely new areas for inpatient palliative care needs.

Improving Advanced Care Planning Documentation In The Outpatient Setting, Carly Sedlock, Md, Tatiana Bekker, Md, Tara Sunder, Md, Mario Caldararo, Md, Divya Chalikonda, Md, Newton Mei, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aims

We aimed to increase Jefferson Hospital Ambulatory Practice (JHAP) electronic medical record documentation of advanced care planning discussion of 209 identified “high risk” patients via independently labeled ACP notes by 5% (from 1.4% to 6.4%) over a six-month period (October 1, 2017- April 1, 2018).9 We elected to focus this pilot project on high risk patients due to time constraints of the study period and we felt that these high risk patients would likely derive the most benefit from ACP planning in the outpatient setting.

Establishing Cost-Effective Management Of Postoperative Urinary Retention After Spine Surgery, Nikolaos Mouchtouris, Md, Catriona Harrop, Md, Edward Kloniecke, Md, Victoria English, Crnp, David Wyler, Md, Kamini Patel, Rn, Mba, Ashwini Sharan, Md, James Harrop, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Goal

Our goal is to develop evidence-based guidelines that:

1. streamline the order/timing of interventions in patients who develop PUR after spine surgery
2. identify those at high-risk of long-term urinary retention that require further workup
3. minimize the rate of PUR –goal is to reduce to 3.5% in FY 2019
4. and determine the cost savings from our intervention when applied to all surgeries

Effective Hepatitis C Screening In High Risk Populations, Aekata Shah, Do, Jennifer Seymour, Do

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Purpose

The purpose of our study was to demonstrate how various quality improvement initiatives activated in selected Jefferson Northeast family medicine teaching offices have enabled effective HCV screening. Given the cost effectiveness of screening and early treatment versus treatment of the disease in the later stages of progression,8 we hope to encourage other primary care offices to implement quality initiatives to encourage appropriate HCV screening. This is especially important for the baby boomer generation, as well as for high risk individuals with a history for and/or current IV drug abuse or other high risk behaviors.

Improving Transitions Of Care For Inpatients With An Egfr < 20ml/Min, Brianna Shinn, Md, Brandon Menachem, Md, Robert Park, Md, Sarah Houtmann, Md, Zachary Lee, Md, Thomas Holden, Md, Tomoyuki Hongo, Md, Vincent Yeung, Md, Goni Katz-Greenberg, Md, Peter Burke, Do, Mba

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

In this study we conducted an analysis of 22 inpatients with an eGFR<20 that revealed there was a greater prevalence of patients without permanent AV access for HD initiation when compared to national data. These findings demonstrated the need for improved transitions of care and timely creation of AV access for this patient population, thus we sought to improve this. This is the first inpatient initiative that our group is aware with the aim of improving timely AV access and transitions of care for an inpatient population (Figure 1).

Process Improvement For Endovascular Thrombectomy In Patients Presenting With Acute Ischemic Stroke, Richard F. Schmidt, Md, Michael J. Lang, Md, Robin Dharia, Md, Fred Rincon, Md, Thomas Zdanowski, Rn, Msn, Robin D'Ambrosio, Rn, Msn, Stavropoula Tjoumakaris, Md, M. Reid Gooch, Md, Pascal Jabbour, Md, Nabeel Herial, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aims

1. Critically evaluate the existing stroke activation and ET protocols for compliance with new 2018 metrics and guidelines.
2. Review DTP times under the existing protocol to assess for potential inefficiencies or gaps in care delivery, specifically addressing differences between processes at JHN compared to ED/Gibbon.
3. Make changes to the existing stroke alert protocol to better reflect current guidelines, streamline care, and ultimately improve process metrics (DTP times).
4. Establish a system for recursive continuous analysis of AIS patients to identify protocol gaps, inefficiencies and areas for further intervention.

Improving Medical And Endovascular Management For Acute Ischemic Stroke Through Multidisciplinary Education And Simulation, Richard F. Schmidt, Md, Megan Margiotta, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Robin Dharia, Md, Maria Aini, Md, Diana Tzeng, Md, Fred Rincon, Md, Pascal Jabbour, Md, Nabeel Herial, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Primary goals:

1. Reduce door to treatment times (both DTN and DTP) to meet and exceed existing guidelines metrics.
2. Educate residents about acute stroke management, including national guidelines and new institutional protocols to improve efficiency during stroke alerts.

Get With The Rhythm – Telemetry Education In Internal Medicine Residency, Rashesh Shah, Md, Hanna Sofie Ellingsen, Md, Molly Halloran, Md, Reetu Mukherji, Md, Juergen Kloo, Md, Yair Lev, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aim

• Our aim was to design and implement cardiac monitoring education for medical residents in order to help residents feel more comfortable navigating and assessing telemetry.
• Our objective was to create and pilot a telemetry education video among Internal Medicine residents (from March to May 2018) resulting in a 75% increase in ability to demonstrate essential telemetry skills as determined by a pre and post video assessment.

Adaptation Of A Standardized Handoff System For A Radiology Residency Program, Riti Kanesa-Thasan, Md, Liya Gendler, Md, Megan Margiotta, Md, Kristin Lohr, Md, Grant Turner, Md, Rebecca C. Jaffe, Md, Christopher G. Roth, Md, Suzanne Long, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background/Objectives:

• The Joint Commission has linked communication failure as a root cause for a majority of sentinel events.
• The “I-PASS” system is a hand-off mnemonic that has been shown to decrease medical errors, prevent adverse events, and improve communication.
• Multiple Jefferson residency programs have adopted I-PASS training over the last year to standardize sign-outs between treatment teams and departments.
• Radiology residents also participate in hand-offs with other departments, especially in cases of adverse patient reactions that occur within radiology (ie: allergic reaction, seizure, contrast extravasation). In addition, radiology residents also participate in hand offs between daytime and overnight teams, including …

Cross-Departmental Educational Program On Complex Airway And Epistaxis Management, Adam Vasconcellos, Md, Meghan Crawley, Md, Michael Topf, Md, Ryan Gerritsen, Md, Dominick Gadaleta, Md, Joseph Spiegel, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Internists, emergency medicine physicians, and intensivists routinely provide essential care for patients with complex airways (i.e. tracheostomy and laryngectomy) and patients with epistaxis. Any of these physicians may serve as first responder in a complex airway or epistaxis emergency situation. Therefore, a basic understanding of complex airway and epistaxis management is essential. The otolaryngology department aims to provide our colleagues with fundamental take-home points to improve crossdepartmental care of these patients.

Utilizing Feedback As A Mechanism To Improve Resident Event Reporting Rates, Grant Turner, Md, Kristin Lohr, Md, Ben Jones Jr., Md, Emma Lundsmith, Md, Megan Margiotta, Md, Riti Kanesa-Thasan, Md, Bracken Babula, Md, Rebecca C. Jaffe, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

• Provide feedback to 100% of residents entering a report between December 2017 and March 2018
• Evaluate the degree to which residents value the feedback we were able to provide
• Assess a pilot process for sustainability on a larger scale

Hey, What’S The Delay? An Evaluation Of Reporting Time For Pediatric Eegs, Aparna Polavarapu, Md, Rachit Patil, Md, Maromi Nei, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aim

To determine if there is a reduction in time to EEG reporting after institution of the Pediatric Epilepsy fellowship track.

Implementation Of A Volunteer-Based Hospital Program For Older Adults, Elizabeth Collins, Md, Kristine Swartz, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

• A multi-faceted, volunteer-led, hospital-based program1has been shown to: •Reduce the incidence of delirium •Decrease hospital length of stay •Reduce hospital costs.
• Implementation of such a program requires upfront investment.
• A smaller, volunteer-based visitation program for older adults may provide support for the allocation of more hospital resources in delirium prevention and establishment of a formal Hospital Elder Life Program1in this institution.
• This research aims to investigate: •If the implementation of a visitation program is feasible at this hospital •Volunteer experience with the program.

Handoff Training In Undergraduate Medical Education – Identifying And Closing The Gaps, Gregory Troutman, Jeffery Head, Andrew Day, John Hafycz, Lauren E. Grunenwald, Kelly Daniels, Kevin He, Rebecca Montana, Alexis Wickersham, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives:

• Our study sought to assess differences in perceptions and the use of standardized handoff tools between medical students near completion of their third and fourth years of medical school at Sidney Kimmel Medical College.
• We hope to use this information to create targeted medical education interventions to better expose pre-clinical medical students to standardized handoff tools in the first and second years of medical school, before entering the wards.

The Effects Of Office-Based Interventions To Increase Patient Enrollment In An Online Electronic Medical Record Portal, Lionel Mcintosh, Md, Allison Rague, Md, Claire Thesing, Md, Amy Lachewitz, Md, Gillian Love, Md, Daniel Sizemore, Md, Zachary Klock, Md, Aimee Mcmullin, Md, Zeynep Uzumcu, Md, Patrick Mcmanus, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

We aimed to increase the number of JFMA patients signed up with MyChart by 50% over a 5 month time frame by educating providers and staff on ways to implement patient portal sign up into the office visit as well raising awareness of the portal for both providers and patients

Awareness During An Intensive Care Unit Procedure: A Root Cause Analysis And Creation Of The D5 Handoff Tool, Elise Strickler, Do, Bryan Lutman, Do

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

The objectives of this study are to:

1. perform root cause analysis of the systemic causes of an incident of awareness that occurred during bedside EGD and
2. create a handoff tool that is easily remembered that conveys the essential information about ICU intubations.

Bad Out Of The Box: A Report On Pre-Operative Failure Rates Of Reusable Flexible Ureteroscopes At A Single Institution, Whitney R. Smith, Brian P. Calio, Scott G. Hubosky, Kelly A. Healy, Demetrius H. Bagley

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Purpose: Single-use flexible ureteroscopes offer the advantage of being consistently functional and perfect for immediate clinical use right “out of the box.” Cost is the barrier to widespread acceptance of these instruments. Economic models have been put forth which compare the expense of acquiring and maintaining reusable flexible ureteroscopes to that of using single-use flexible ureteroscopes.However, one poorly defined variable in these models is the frequency of encountering an unsuitable reusable flexible ureteroscope at the beginning of a case. We sought to define this in a consecutive series of patients undergoing flexible ureteroscopy.

Patients and Methods: Prospective analysis of all …