Medicine and Health Sciences Commons^™

The Handoff Culture: Can We Change How An Icu To Floor Transfer Works?, Kristin Lohr, Md, Grant Turner, Md, Allison Greco, Md

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

Handoffs between providers have increased following the implementation of the 2011 Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions. Properly structured and timed handoffs are essential to patient safety.1 Despite this, studies have shown that errors in code status, medication allergies, and important updates to the problem list are common, all of which can lead to adverse outcomes to patients.2

At Thomas Jefferson University Hospital (TJUH) the 2016 Safety Culture Survey revealed that across all specialties, 37% of residents felt that things “fall through the cracks” when transferring patients from one unit to another.

Our interdepartmental Housestaff Quality …

Improving Blood Donor Diversity Through Focused Recruitment Interventions, Sarah Amanullah, Vandi Ly, Md, Amanda Pirilli, Md, Julie Karp, Md

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

Study Design:

Beginning in May 2016, the Jefferson Blood Donor Center began collecting donor self-identified race/ethnicity: White, Black or African American, Hispanic, Asian or Pacific Islander, American Indian or Alaskan Native, Multiracial, Other, Unknown (Figure 1).

We retrospectively quantified the racial/ethnic groups represented in each month’s donor population.

In January 2017,the following intervention strategies were implemented:

Emailing donors who self-identified as part of a racial/ethnic minority group

Contacting racially/ethnically-focused student groups to organize blood drives with the Jefferson Blood Donor Center

Partnering with the Jefferson Medical Oncology Society MarrowthonDrive to encourage blood donations

Presentation to the local chapter …

It's Midnight. Do You Know How Your Patient Is Doing?, W. Alswalmeen, Md, K. Foley, Md, K. Noonan, Md, R. Josloff, Md

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

Transitions of care are vulnerable points in patient care. With the volume of information transferred, quality of care and patient safety are at risk. Numerous attempts at standardization of transitions of care have been utilized; however no consensus regarding the optimal method has been reached. We developed a “watcher” model in addition to standard end of shift sign out. Patients at risk were identified by the day team and seen overnight by a senior and junior surgery resident, along with a nursing representative: either a bedside RN or nursing supervisor. We hypothesized that these midnight rounds could proactively identify patient …

Improving Resulted Hemoglobin A1c Rates: A Feasibility Study For Point-Of-Care Hemoglobin A1c Testing At An Urban Family Medicine Office, Phoebe Askie, Md, Mph, Daniel Chung, Md, Laura Parente, Md, Yury Parra, Md, Grace Amadi, Md, Mariana R. Kuperman, Md, Mph, Bruce Reaves, Md, Miranda Aragon, Md, Kyle Bardet, Md, Sunny Lai, Md, Anna Woods, Md, Marc Altshuler, Md

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

Study Aims:

• Our practice’s goal is to increase the number of up to date hemoglobin A1c for diabetic patients seen at JFMA in order to help improve glycemic control
• The aim of this study is to see if point of care (POC) hemoglobin A1C is a feasible way to increase the number of up to date hemoglobin A1C. We looked at various factors including timing, training, and flow.

Maintaining Continuity In A Resident Run Clinic-Impact Of The 6+2 Scheduling., Odunayo Banjoko, Md, Doron Schneider, Md, Rachel Ramirez, Md

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

Objective:

The aim of this study was to evaluate the continuity of care with regards to follow up with the same team (and optimally same resident) 1 year prior to implementing the 6+2 scheduling block and 1 year post schedule block change.

Standardization Of Monofilament Use In A Resident-Run Clinic, Odunayo Banjoko, Md, Doron Schneider, Md

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

Study Aim:

The aim of this study was to improve incidence of regular foot exams among clinic diabetic patients.

Quantifying Patient Reported And Documented Compliance With Adjuncts To Venous Thromboembolism Prophylaxis, Tyler M. Bauer, Md, Katerina Dukleska, Md, Adam P. Johnson, Md, Mph, Johanna Beck, Myles Dworkin, Kamini D. Patel, Rn, Geno J Merli, Md, Scott W. Cowan, Md

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

Objectives:

1. Measure patient compliance with pharmacologic, mechanical and ambulatory prophylactic measures.

2. Evaluate for agreement between nursing documentation and patient reported compliance with mechanical and ambulatory prophylactic measures.

Beat To Beat: Implementing A Tailored Literature Review E-Newsletter For A Multidisciplinary Subspecialty Group, Shashank Behere, Md, Steven Ritz, Md

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

Objective:

To increase availability and exposure to recent, relevant, reliable literature from a range of sources, for a multidisciplinary cardiac center, by creating an e-newsletter summarizing articles of interest.

Shedding Light On The Off-Hours Coverage Gap In Radiology: Improving Turnaround Times And Critical Results Reporting, Gilda Boroumand, Md, Jaydev K. Dave, Phd, Ms, Christopher G. Roth, Md, Ms-Hqs

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

Objective:

Devise a plan to optimize off-hours faculty and trainee staffing within the Department of Radiology

Measure the magnitude of patient safety gains in terms of report turnaround times (TAT) and critical results communication times (CRC)

Risk Factor Analysis For 30-Day Readmission Rates Of Newly Tracheostomized Children, Jenna Briddel, Md, Abigail Strang, Md, Jessica Levi, Md, Patrick Barth, Md, Aaron Chidekel, Md, Udayan Shah, Md

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

Objectives:

Pediatric patients undergo tracheostomy for a variety of reasons; however, medical complexity is common among these patients. Although tracheostomy may help to facilitate discharge, these patients may be at increased risk for hospital readmission. The purpose of this study was to evaluate our institutional rate of 30-day readmission for patients discharged with new tracheostomies and to identify risk factors associated with readmission.

Study Design:

A retrospective cohort study was conducted for all pediatric patients ages 0-18 years with new tracheostomies at our institution over a 36-month period.

Methods:

A chart review was performed for all newly tracheostomizedchildren from 2013 …

A Quality Improvement Project To Reduce The Wait Time For Initial Appointment In An Urban Outpatient Sleep Center, Anasua Chakraborty, Md, Ritu G. Grewal, Md

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

Project Aim:

In this study we aimed to see if replacing one face to face follow up visit after sleep study with a phone call by a trained office staff will

-decrease the total number of follow up office visits, thus decreasing health care cost

-increase the number of new patients seen during the 6 month follow up period

-Did not decrease patient compliance.

Vaginal Preparation With Povidone Iodine Prior To Cesarean Delivery, Laura Felder, Md, Amanda Paternostro, Md, Johanna Quist-Nelson, Md

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

Objectives: To reduce the rate of postoperative endometritis in patients undergoing cesarean delivery by implementing a new departmental guideline for vaginal preparation prior to cesarean sections, after labor or rupture of membranes

Contact Precautions-How Patient Centered Are They?, Eloho Edosio, Md

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

Method:

The data collecting tool was a questionnaire that consisted of 11 questions structured to measure satisfaction with the quality of education provided before CP was implemented and also to evaluate overall satisfaction with the quality of health care provided by the hospital. A trial run was performed before it was administered to patients in the study group. The study group consisted of patients on CP from April till May 2017.

Improving The Patient Colonoscopy Prep Experience, Natalie Cosgrove, Md, Andrew Dargan, Md, Raja K. Dhanekula, Md, Gloria Francis, Md, Komal Gandhi, Md, Andrew Kistler, Md, Mark Malamood, Md, Bolin Niu, Md, Sheela S. Reddy, Md, Apeksha Shah, Md, Christina Tofani, Md, Andrew Zabolotsky, Md, Robert Cohen, Md, Stephanie M. Moleski, Md, Jorge Prieto, Md

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

AIM:

To improve patient prep compliance, prep quality, and an overall better experience by designing a prep specific website that will address the most common prep questions and concerns

Once launched, the website address will be placed on printed colonoscopy prep instructions and stated on the after hours GI clinic voicemail as an additional patient resource

Utilization Of A Multimodal Preoperative Pain Regimen Prior To Gynecologic Oncology Exploratory Laparotomies, Lauren C. Hand, Md, Alison Vogell, Md, Talia Maas, Md, Kristina Masi, Md, Rebecca J. Mercier Md Mph, Norman G. Rosenblum, Md, Phd, Christine H. Kim, Md

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

Objective:

The aim of this study was to evaluate the use of a combination of non-opioid preoperative pain medications including Tylenol, Lyrica, and Celecoxib (TLC) in patients undergoing gynecologic oncologic exploratory laparotomies. We evaluated postoperative narcotic use in morphine equvalents (ME) as well as pain scores, anti-emetic use, and length of stay.

How Good Are We At Determining Risk? Quantifying The Accuracy Of Clinician Determined Risk For Vte Prophylaxis, Katerina Dukleska, Md, Adam P. Johnson, Md, Mph, Tyler M. Bauer, Myles Dworkin, Johanna Beck, Kamini D. Patel, Rn, Geno J. Merli, Md, Scott W. Cowan, Md

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

Objectives:

Create and validate a simple tool for concurrent audits of risk stratification, compliance and documentation

Evaluate accuracy of clinician risk stratification and prophylatic ordering practice compared with a standardized Caprini RAM across different assigned risk categories

Provide recommendations for EPIC VTE Prophylaxis CDS Development

Quiet In The Operating Room! Team Stepps And Or Distractions, Zabecca S. Brinson, Md, Adam P. Johnson, Md, Mph, Rose Farmer, Rn, Tesa Leonard, Crna, Susan Cacciatore, Rn, Maritza Sanchez, Rn, Lorie Weikel, Rn, Paul Sammut, Rn, Francesco Palazzo, Md

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

Background and Objective:

From the moment that a patient enters the operating room to the time that they are brought to the post anesthesia care unit, a distraction has the potential to lead to an adverse outcome for the patient. During the critical portions of the surgery, it is even more important for all members of the operating staff to be focused and engaging in safe practices. Distractions in the operating room can hinder safe communication and potentially endanger patient safety. Team training has been shown to both improve team communication and reduce distractions.

The objective of this project was …

Transrectal Ultrasound Guided Prostate Biopsy Antibiotic Prophylaxis: Standard Vs. Augmented Antibiotic Regimens, And The Role For Pre-Biopsy Rectal Swab Cultures, Thomas Hardacker, Md, Mba, Danielle Squadrito, Rn, Christopher Caputo, Md, Mark Mann, Md

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

Objectives:

To evaluate peri-procedural antibiotic prophylaxis regimens based on pre-procedural rectal swab cultures.

To evaluate infection rates between transrectalbiopsy patients receiving FQs alone and those receiving ceftriaxone or gentamicin in addition to FQs.

Quality Review Of Irradiated Cellular Blood Product Orders, Matthew Grzywinski, Vandy Ly, Md

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

Objectives:

Our goal is to educate house staff on the indications for irradiated blood products. We hope to reduce the number of inappropriate irradiation orders to less than 50% of the total orders for irradiated blood products and to be followed up over time.

Ambulation Protocols Leading To Decreased Postoperative Complications And Hospital Stay, T. Olszewski, K. Noonan, H. Gold, G. Kelly, E. Youseef

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

Background:

In the postoperative course, patients are routinely encouraged to ambulate as frequently as possible. Typically in the hospital this can become burdensome to the staff and often becomes low priority. Patients are also not aware of the frequency and quality of the ambulation that is sufficient in the postoperative period. At present, patients on the surgical floor who are completely independent and without any devices (eg. Oxygen, nasogastric tubes, chest tubes) are freely able to ambulate at will although there is no reliable way to track this progress. Other patients with devices are limited to waiting for nursing or …

Addressing Barriers To Breast Cancer Screening: Where To Intervene To Increase Mammogram Completion Rates, Jennifer Laporta, Md, Robert J. Mcclowry, Md, Elizabeth "Mackie" Talley, Md, Lionel Mcintosh, Md, Allison Rague, Md, Claire Thesing, Md, Amy Leshner, Md, Gillian Love, Md, Daniel Sizemore, Md, Patrick Mcmanus, Md

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

Methods:

Study sought to determine if an intervention would aid in increasing mammogram screening rates in the Jefferson Family Medicine Associates practice.

Perioperative Glycemic Management, A. Rogers, T. Olszewski, N. Sich, K. Noonan

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

Proposals and Goals:

1. We propose creating a standard easy to use and safe protocol for glycemic management for same day/elective surgical patients.

2. Following implementation in same day and elective surgical procedures, we propose expanding the protocol to be effective in urgent and emergent inpatient surgical procedures.

Philadelphia Drug Monitoring Program And Compliance With Department Of Health Requirements, Paniz Heidari, Do, William Wieczorek, Md, Jayassree Iyer, Md, Denise Pineda-Fortin, Md, Elizabeth Liveright, Md

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

Objectives:

With this newly instituted mandate, we found that many of the resident did not have access to the PDMP query site. Our initial goal is to have 100% of residents have log-in access to the PDMP site. Our long-term goals involve increasing the query of the PDMP website by OB-GYN residents prior to prescribing narcotic pain medication.

There are several changes that we can make to result in improvement of our initial goal including: identifying residents that require access, working with program coordinator to identify gaps in their PDMP application, and assisting in providing DOH with any additional documentation …

Filling The Void: A Low Cost, High-Yield Method To Addressing Incidental Findings In Trauma Patients, N. Sich, A. Rogers, D. Bertozzi, P. Sabapathi, L. Gartner, W. Alswealmeen, P. Lim, J. Sternlieb, J. Yuschak, O. Kirton, R. Shadis

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

In this study we:

Report the incidence of incidental findings in a suburban trauma center treating primarily blunt and elderly trauma

Propose simple solutions to increase the rate of disclosure to patients

Analysis Of Clostridium Difficile Patterns At Thomas Jefferson University Hospital, Andrew Tseng, Kulvir Nandra, Md, Kelly Zabriskie, Phyllis Flomenberg, Md, Scott W. Cowan, Md

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

AIMS:

To analyze CDI patterns to TJUH, particularly in Opportunity Units

To visually examine the relationship between CDI cases within units

Provide data analysis to the CDI working group

Tracking And Improving Bedside Procedures Through Standardized Documentation, N. Sich, L. Gartner, J. Sternlieb, K. Noonan

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

Proposal and Goals:

We propose to create a standardized electronic procedure note that will replace all documentation for bedside procedures without sedation.

◦Makes notes legible and easily identified

◦Allows uniform tracking of metrics necessary to identify outcomes from a procedure (blood loss, specimens, post-procedure studies, complications)

2.The procedure note will be created in such a way as to allow specialized procedures to be added over time with minor customization to improve physician/nursing work flows and increase efficiency

◦Allows procedures to be sorted and tracked by type

◦Will be constructed to allow attaching CPT codes to patient charts via documentation

3. …

Increasing Effectiveness Of The Surgical Airway Response System: Introduction Of The Otolaryngology Airway Pager, Quality Improvement Project Of The Pgy-2 Class, Erin Reilly, Md, Lauren Galinat, Md, Ryan Rimmer, Md, Gregory Epps, Md, Nikolaus Hjelm, Md

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

Introduction:

The need for an Otolaryngology airway pager is based on several external and internal factors. The current communication pathway for emergent airways at our institution is well established but often misinterpreted. The protocol is outlined in Figure 1. The priority to reach out to other departments is based on their availability of an attending in house overnight. Furthermore, there is often a delay in contacting the Otolaryngology department. Our service has multiple pagers to accommodate for each of our inpatient teams, which can be confusing for other services. One of the driving events for this project was an incident …

Increasing Ultrasound-Guided Thyroid Biopsy Yield, T. Conor Mckee, Md, Christopher G. Roth, Md, Ms-Hqs

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

Objectives: Conduct Plan-Do-Study-Act (PDSA) performance improvement project to improve thyroid biopsy yield
Short Term>reduce unsuccessful biopsies by 50% Long-Term>eliminate unsuccessful biopsies

Improving Proficiency In Central Venous Catheter Insertion: Standardized Simulation Based Training For Internal Medicine House Staff, John Madara, Md, Christoph Hutchinson, Md, Ma, Frances Mae West, Md, Ms

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

Objectives:

The objectives of this study are to assess residents' pre-workshop ability and comfort with CVC placement, undergo a standardized online didactic and hands-on clinical training simulation workshop, and subsequently undergo a proficiency test using simulation models to assess competency. The goal of a standardized training module is to create a universal approach to CVC placement in our institution and improve comfort and technical ability of house staff. We hypothesize that this will reduce complications and improve patient care and safety.

Consolidation Of P2y12 Testing While Maintaining Quality And Turnaround Time, Geetha Jagannathan, Mbbs, Jerald Z. Gong, Md

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

Objective:

To consolidate the test performed at 2 different locations at 1, thereby improving cost effectiveness while maintaining quality and result turnaround time.