Medicine and Health Sciences Commons^™

Quality Of Post-Discharge Follow-Up In Patients Admitted To Tjuh With Intermediate High Risk Pulmonary Embolism, D. Kramer, P. Kirupaharan, M. Flamenbaum, M. Scharf

House Staff Quality Improvement and Patient Safety Conference (2020-)

• Our institution has developed a multidisciplinary pulmonary embolism response team (PERT) to help in the management of patients with intermediate high risk pulmonary embolism
• While the PERT focus is on acute inpatient management, it is important that PERT patients have close follow-up to monitor for known future complications including thromboembolic pulmonary hypertension (CTEPH) and chronic pulmonary embolism syndrome
• CTEPH, in particular, is a potentially treatable disease with significant morbidity if left untreated
• Therefore, an underappreciated and important aspect of the PERT team should be the coordinated follow-up and long term care of these patients
• We wanted to better understand how …

Improving Utilization Of Sglt2 Inhibitors In The Inpatient Setting, Andrea Verghese, Md, Bharaniabirami Rajaram, Md, Fred Karaisz, Md, Jason Ho, Md, Kaya Patel, Md, Michael Grodsky, Md, Shifa Gandhi, Md, Xuejun Wang, Md, Yair Lev, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

• SGLT2 inhibitors have been shown to have a significant benefit for patients with DM2 or CAD (DAPA-HF, Emperor-reduced)
• The usage of these medications are low compared to other Goal Directed Medical Therapy.
• There are multiple contributing factors as to why these medications are underutilized

Our aim is to assess barriers against prescription of SGLT2-i at the time of discharge from TJUH and to increase utilization after placement on formulary.

Tolerability Of Switching Cholinesterase Inhibitors To Memantine Monotherapy Versus Adding Memantine As Combination Therapy For All-Cause Neurodegenerative Disorders, Estevana Isaac, Md, Mijail Serruya, Md, Phd, Keith Scott, Phd, Michael R. Sperling, Md, Carol Lippa, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Background: Prior studies have focused on the clinical efficacy of combination therapy, Donepezil and Memantine, for patient’s diagnosed with Alzheimer’s disease. However, the potential adverse drug reactions while described as mild can have serious sequelae in older adults who are already managing the side effects of polypharmacy.

Objective: This study looks to explore the tolerability of switching cholinesterase inhibitors to memantine monotherapy versus adding memantine as combination therapy for all-cause neurodegenerative disorders.

Methods: The study is a retrospective chart review that includes 175 patients aged 50 and older diagnosed with neurocognitive disorders (ICD 10 F00-F03.91 and ICD10 G30-G31.84) managed on …

Postoperative Aspiration Pneumonia (Popna) Prevention Protocol, R. Lamm, Md, D. Pace, Md, B. Till, Md, B. Creisher, J. Curran, E. Foecke Munden, J. Williamson, Iii, S. Cowan, Md, C. Costanzo, Md, Harish Lavu, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

• Postoperative pneumonia increases morbidity, mortality, length of stay, and hospital costs up to $12,000-$40,000 per patient
• TJUH Center City ranked in the top 3rd - 4th quartile of pulmonary complications on the 2020 National Surgical Quality Improvement Program perioperative review
• ICOUGH protocol: widely accepted, standardized set of post-operative interventions to reduce pneumonia incidence
• Survey design: measure ICOUGH compliance before and after implementation of resident note checklist in EPIC

Utilization Of A Palliative Care Trigger In The Surgical Intensive Care Unit, Gillian Love, Md, Shawn Mangan, Msn, Rnfa, Anp-Bc, Agacnp-Bc, Michelle Mckay, Phd, Rn, Ccrn, Joshua Marks, Md, Facs, John Liantonio, Md, Mba, Hmdc

House Staff Quality Improvement and Patient Safety Conference (2020-)

• Our project aims to expand palliative care availability in the SICU by implementing a consult trigger program.
• We also aim to learn about and measure compassion fatigue of providers within the SICU.

Improving Colon Cancer Screening Rates In An Ambulatory Resident Clinic, Ashima Oza, Md, Tina Boortalary, Md, Elizabeth Chin, Md, Tudor Sturzoiu, Md, John Wallis, Md, Sonia Bharel, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

In the US, colorectal cancer (CRC) is the third leading cause of cancer-related deaths. According to the 2018 CDC Behavioral Risk Factor Surveillance System survey, 68.8% of US adults between 50 and 75 were up to date on colorectal screening (CRCS) across all screening modalities. In light of the COVID-19 pandemic, screening has dropped even further and is still 50% below pre-pandemic levels. At Jefferson, our CRCS rate is below the national average at 55.4%. Given the importance of regular screening for CRC prevention, this is clearly inadequate. There are several barriers to completing an invasive screening modality like a …

Improving The Virtual Neurosurgery Residency Interview Experience, Ellina Hattar, Md, Omaditya Khanna, Md, Ritam Ghosh, Md, Nikolaos Mouchtouris, Md, Kevin Hines, Md, Daniel Franco, Md, Michelle Hoffman, James S. Harrop, Md, Ashwini D. Sharan, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

The residency selection process has proven a challenge in the face of the Covid-19 pandemic. In the neurosurgery match, residents are chosen based on objective metrics as well as their ability to effectively work as part of a team tasked with caring for medically complex patients faced with neurosurgical conditions. As there remain limitations on the number of externships students could participate in and the Step 1 examination is expected to be reported as either pass or fail in years to come, we will have fewer objective metrics to review in the student application. We conducted a study to best …

Evaluating The Reliability Of The Problem List For Comorbidity, Joseph W. Schaefer, Alan A. Kubey, Md, Michael Li, Phd, Novel Covid Learning Group

House Staff Quality Improvement and Patient Safety Conference (2020-)

The problem list in EPIC provides a centralized source of patient medical conditions that informs medical decision making. This is especially important for COVID- 19 patients where risk scores such as the “4C score” inform care.

The goal of this study was to identify the accuracy of the problem list and identify areas for future improvement.

A Safety Assessment Of The Re-Opening Of An Academic Medical Center Outpatient Endoscopy Unit During The Covid-19 Pandemic, Scott Manski, Christopher Schmoyer, Alice Pang, Richard Denicola, Amy Javia, Melissa Vitolo, Linda Yan, Christopher Cao, Brianna Shinn, Divya Chalikonda, Giselle Mahoro, Ritu Nahar, Joshua Lieberman, Micaela Gernhardt, Neveda Murugesan, Alexandra Leto, Ryan Erwin, Taylor Kavanagh, Stephanie Moleski, Robert Coben, Mitchell Conn

House Staff Quality Improvement and Patient Safety Conference (2020-)

• This study aimed to assess outcomes and satisfaction among patients undergoing outpatient endoscopic procedures during the COVID-19 pandemic
• Identifying the rates of COVID-19 symptom development and post procedure testing would provide critical information on patient safety
• Assessment of patient experiences would serve as a guide for potential areas of improvement
• We predicted that with proper protocols in place, outpatient endoscopy was a safe and positive experience

Addressing Health Disparities And Access In The Department Of Neurology Outpatient Setting In The Era Of The Covid-19 Pandemic: A Quality Improvement Initiative, V. Wang, M. Rehman, K. Burda, L. Liao, M. Braslavsky, T. Chuang, J. Diep, Md, E. Isaac, E. Wong

House Staff Quality Improvement and Patient Safety Conference (2020-)

Neurology, a largely outpatient specialty, has joined many other fields in the endeavor of incorporating telemedicine.^4,6,7 We present the results of analysis of the Epic Electronic Medical Record (EMR) of all outpatient visits from the Thomas Jefferson University Hospital Department of Neurology from 2019 to 2020 in order to identify areas of ethnic minority and geographic disparities with regards to usage of telemedicine. For our analyses, we have included Neurology patients across the General Neurology (JUP Neurology 909 Walnut NEU), Headache Center (HA), and Multiple Sclerosis Center (MS). Additionally, based on patient surveys from a subset of our outpatient …

Preventing Iatrogenic Pneumothorax “Just-In-Time”, Jason Ho, Md, Ammar Saati, Md, Ryan Commins, Md, Justin Henneman, Md, Frances Mae West, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

• In 2020 a high incidence of iatrogenic pneumothorax was noticed at TJUH after internal jugular central line insertion - Accepted rate is 0.1%
• With long periods of time between ICU rotations, residents suffer from significant procedural skill decay
• The COVID-19 pandemic brought with it an increase in the number of central lines placed
• During the COVID-19 pandemic, there has been a lack of large group training opportunities due to social distancing constraints

By December 31st 2021, our intervention will improve rates of iatrogenic pneumothorax after US-guided internal jugular central line insertion by 50% of baseline, as measured by chart review …

Reforming The Pre-Operative Clearance Process In The Covid-19 Era, Ritam Ghosh, Md, René Daniel, Md, Jesse Edwards, Md, Catriona Harrop, Md, Janeen Duckworth, Msn, Amy Della Penna, Msn

House Staff Quality Improvement and Patient Safety Conference (2020-)

The problem at hand was increasing cancellation rates, increasing frustration amongst physicians, and lack of communication which guided our interventions

Some of the interventions used to improve the process are:

• PAT practioners routinely checking laboratory tests after the initial visit
• PAT practioners routinely documenting addendums in medical record in order to improve transparency and medical record
• Two step verification process: residents/surgeons going through medical record and communicating to PAT practioners if clearance was not ironclad
• Consulting physicians (i.e. cardiologists) with improved communication and documentation with PAT practioners in the event of additional testing necessary prior to clearance
• PAT physicians communicate …

Developing A Home Based Chemotherapy Model, George Xiangyun Ye, Nathan Handley, Md, Mba, Maria Piddoubney, Pharmd, Gloria Espinosa, Pharmd, Judith Alberto, Pharmd, Adam Binder, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Lessons Learned

• Based on our criteria, most medications can be administered in the home setting.
• A major barrier to administration at home is stability of medications at room temperature. This issue can be addressed by transporting and storing the medication in a refrigerated container.
• Expectedly, injectable drugs and medications with short infusion times that are stable at room temperature would be easiest to administer at home.

Early Follow-Up Phone Calls To Reduce 30-Day Readmissions For Stroke Patients Discharged To Home, Olivia Gruder, Md, John Allred, Md, Frank Anzelmi, Md, Judy Diep, Md, Belle English, Md, Aniket Natekar, Md, Priyadarshee Patel, Md, Louis Porreca, Md, Sanskruti Patel, Md, Shaista Alam, Md, Rodney Bell, Md, Robin Dharia, Md, Elan Miller, Md, Diana Tzeng, Md, Fred Rincon, Md< Msc, Facp

House Staff Quality Improvement and Patient Safety Conference (2020-)

Patients admitted to the acute stroke unit with minor neurologic deficits are frequently discharged directly to home rather than to a rehabilitation center. Data from our tertiary care comprehensive stroke center has shown that in a 7-month period, 37% of patients admitted to the stroke unit were discharged home versus discharged to rehab or other location. Our average 30-day readmission rate for home discharges is 5.14%. More than 30% of these readmitted patients had been discharged on a Thursday or Friday on their index admission. When discharged home, patients typically are tasked with several responsibilities including but not limited to …

Improving Patient Safety Through A Postoperative Debriefing Initiative, Ellina Hattar, Md, Monica Young, Dnp, Mba, Rn, Cnor, Erin Leonetti, Rn, Omaditya Khanna, Md, Anthony Stefanelli, Md, James Harrop, Md, Ashwini Sharan Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Aims for Improvement

Effective and clear communication in the operating room is a necessary aspect of any surgery. Every member of the operative team is integral in fostering an environment focused on patient safety. As such, the institution of a postoperative debrief session may allow for feedback from every member of the team that will ultimately aid in improving a patient’s experience.

Reading Room Assistance Pilot: Improving Radiologist Workflow, Michael Hoy, Md, Christopher G. Roth, Md, Ms-Hqs, Rashmi Balasubramanya, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Aims for Improvement

Our aim for improvement was to find ways to decrease distractions and phone calls in the body radiology reading room and to convert unpredictable and “immediate-response distractions” to “managed distractions” that can be addressed without aborting patient care/case interpretation immediately and unnecessarily. The goal was to decrease interruptions which would allow more time to be spent on reading cases, learning, and teaching. One metric that we identified was the number of phone calls to the reading room, which we intend to decrease by 50% within the first quarter. Another metric was the radiology attending and resident attitudes …

Strengthening The Synapse Between Outpatient Neurological Care And Inpatient Referral, T. Y. Chuang, M. Braslavsky, E. Isaac, M. Rehman, C. S. White, S. Thummalapenta, P. Kerns, D. Rose, E. Wong

House Staff Quality Improvement and Patient Safety Conference (2020-)

Objective

The goal of this project is to investigate if established neurology patients are appropriately referred to the emergency room. We suspect that there are patients that could be more effectively triaged to prevent unnecessary visits to the emergency department. If this is the case, implementing an intervention such as offering expedited visits or contingency plan, may reduce non-emergent inpatient consultative services5. This would also improve outpatient communication and decrease utilization of both ER and patient resources.

Preventing Prostate Biopsy Complications: To Augment Or To Swab?, L. Glick, S. Vincent, T. M. Han, C. Caputo, D. Squadrito, J. Y. Leong, C. Fonshell, K. Syed, J. F. Danella, S. Ginzburg, T. J. Guzzo, M. Hagg, J. D. Raman, M. Smaldone, R. G. Uzzo, J. J. Tomaszewski, A. C. Reese, E. J. Trabulsi, L. G. Gomella, M. J. Mann

House Staff Quality Improvement and Patient Safety Conference (2020-)

Aims for Improvement

• The aim of this study was to determine the antibiotic prophylaxis associated with the fewest infectious complications following prostate biopsy
• Determining the safest method allows the Jefferson Department of Urology to modify its biopsy protocol and improve the rate of post-biopsy complications

Stepwise Implementation Of Vaginal Cleansing And Azithromycin At Cesarean Delivery To Decrease Postoperative Infections; A Quality Improvement Study, Julie Gomez, Ms, Johanna Quist-Nelson, Md, Laura Felder, Md, Daniele Dimascio, Md, Rebecca Eckler, Md, Amanda Paternostro, Md, Michael Posencheg, Md, Jason Baxter, Md, Vincenzo Berghella, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Aims for Improvement

We aimed to decrease our SSI rate by 30% by sequential implementation of vaginal cleaning1,2 and azithromycin3 for women who underwent a CD after having labored or experienced rupture of membranes.

Use Of Visual Aids In Improving Immunization Rates, Kuljit Kaur, Do, Jennifer Brennan, Do, Manuela Modelowski, Do, Olubunmi Olarewaju, Do, Anthony Abbruzzi, Do

House Staff Quality Improvement and Patient Safety Conference (2020-)

We assessed the use of visual aids in vaccine administration in the outpatient setting. Specifically, our objective was to determine if placing visual aids outlining vaccine guidelines in the adult outpatient primary care office would increase the compliance rate of immunizations; and if so, to what degree.

Improving Osteoporosis Screening Rates In A Primary Care Practice Using An Emr-Based Intervention, Conor Murphy, Ashley Barnes, Rukaiya Bashir, Peter Block

House Staff Quality Improvement and Patient Safety Conference (2020-)

Objective

• Osteoporosis is defined as a T-score ≤ -2.5 on DEXA or history of fragility fracture
• Affects a significant proportion of our population over 65 with an estimated annual cost burden of $22 billion
• Only 46% of females over 65 years of age had been screened for osteoporosis at JHAP
• Our study aims to increase that percentage between July 2019 and July 2020 from 46% to 60%

Small Bowel Obstruction: Facilitating Diagnosis And Optimizing Resuscitation And Management, Quinton Campbell, Md, Ryan Bateman, Md, Alex Mercado, Do, James Cirone, Do, Robin Naples, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Objective

• Standardize practice patterns and improve consistency in procedure documentation in ED management of Small Bowel Obstruction (SBO)
• Significant practice variability exists among ED providers for SBO management, specifically in regard to utilization of diagnostic imaging as well as rates of NG tube (NGT) placement and subsequent documentation
• Data review performed by our group demonstrated that of all NG tubes placed, only 61% were documented
• Wide range of practice patterns for diagnostic imaging (see graphics in Results)

Implementing A Surgical Pre-Operative Checklist: Improving Transparency & Communication, Ritam Ghosh, Md, James Harrop, Md, Jesse Edwards, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Our goal was to first analyze what the current practice was and if there was a need for improvement. To our knowledge, each surgical service has its own preop protocol and this is not standardized across the hospital. Furthermore, very few services have EPIC based protocols that allow for documentation and information sharing. For example, the neurosurgery service uses paper checklists, a style that is effective yet outdated.

A survey was sent out to multiple departments in order to gauge the current landscape of pre-operative care. Questions were posed to analyze if there was a need for improved documentation by …

Improving Outpatient Pneumococcal Vaccination Rates In Patients Age <65, Evan Nardone, Md, Mark Mallozzi, Md, Alvin George, Md, Christine Kurian, Md, Omar Safdar, Md, Timothy Kuchera, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Objectives

• To increase pneumococcal vaccination rates for patients 19-64 at JHAP to reach 70% over 3 months.
• To increase resident knowledge of indications for pneumococcal vaccination in patients 19-64 by 25% over 3 months

Asymptomatic Fluid Collections Following Distal Pancreatectomy – Is Intervention Warranted?, Elwin Tham, Md, Emily Papai, Ms, David Nauheim, Ms, Michael Morano, Ms, Nicole Wagner, Ms, Shawnna Cannaday, Crnp, Theresa P. Yeo, Phd, Geoffrey Krampitz, Md, Phd, Charles J. Yeo, Md, Harish Lavu, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Objective

To determine the incidence, associated factors, natural history, and interventions for FCs.

Identifying Women With Coronary Artery Disease Using Non-Cardiac Ct Imaging, Rachel Redfield, Md, Rani Rajaram, Md, Kathryn Anderson, Ba, Sarah Kamel, Md, Matthew Metzinger, Mba, Lydia Liao, Md, Katherine Sherif, Md, Yair Lev, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Aims

• Identify the percentage of female patients with prior CT scans done for noncardiac reasons who should have the diagnosis of CAD.
• Collaborate with primary care, cardiology and breast imaging to determine how best to integrate this incidental finding into clinical practice.
• Determine current barriers that may prevent providers from taking action on patients with new CAD.

Hepatitis A Vaccination Program In Jefferson Emergency Departments, Katelyn Levy, Md, Belinda Lao, Md, Mitchell Berman, Md, Joseph Jean, Md, Sejal Patel, Pharmd, Benjamin Slovis, Md, Scott Sutherland, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

Aims for Improvement

Increase the rate of hepatitis A vaccination in high-risk patients (homeless and drug users) who present to Thomas Jefferson University Hospital and Jefferson Methodist emergency departments over a 5 month period starting on 9/4/2019.

General Surgery Mobile Procedure Cart: Providing Safe And Efficient Procedure Based Care To The Bedside, Ryan Lamm, Ellen Caparosa, James Fraser, Lindsay Lynch, Uzma Rahman, Lindsay Weil, Harish Lavu

House Staff Quality Improvement and Patient Safety Conference (2020-)

Objective

To create a mobile supply cart with all necessary supplies needed for the most common general surgery bedside procedures in order to decrease the amount of times residents need to “shop” for supplies from other locations and prevent delays in procedures to get supplies that are not available. In turn, this will increase patient safety and quality of procedure-based care delivered.

Obstacles To Nurse-Performed Ultrasound Guided Peripheral Iv Placement, Ali Elsaied, Do, Farhan Khan, Do, Rishi Kalwani, Md, Cara Kanter, Md, Kenn Ghafferian, Do

House Staff Quality Improvement and Patient Safety Conference (2020-)

With an aging population, the rate of obesity, the regional prevalence of dialysis patients and the increase in IV drug abuse, obtaining routine vascular access in the emergency department (ED) has become more challenging. Ultrasound (US) guided IV placement has been pivotal in identifying deeper veins to access. This is traditionally performed by ED physicians, however given the time constraints, lower acuity patients who require US IV access can experience significant delays to care. We attempted to train ED nurses to perform this skill, however many trained nurses are still not attempting US IVs regularly. This study aimed to identify …

Quick Response (Qr) Code Based Just-In-Time Training Platform For Seldom Used Anesthesia Equipment, Daniel Katz, Do, Sean Washek, Do, David Barnabei, Do, Andrea Creamer, Md, David Nelson, Md, Mba

House Staff Quality Improvement and Patient Safety Conference (2020-)

Aim for Improvement

This quality improvement initiative aims to introduce, improve, and maintain proficiency with seldom used critical pieces of anesthesia equipment prior to use in emergent clinical situations through the following

• Provide just-in-time usage instructions through smartphone technology
• Remove barriers that lead to unfamiliarity with rarely used equipment, we hope to reduce patient safety incidents due to improper usage

The aim was to improve the department’s familiarity and self-reported competence with seldom used equipment by at least 50%