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Increasing Patient Satisfaction With Hospital Meals Through Cost-Effective Interventions, Venus Barlas, Diane Sun, Alexandra Mang, Tomas Escalona, Matt Whicker, Jens Langsjoen

Quality Improvement/Patient Safety Symposium

Background:

According to the 2019 Press-Ganey survey results, UNMH ranks low on overall patient satisfaction compared to peers within the University HealthSystem Consortium. Poor patient satisfaction with quality of food at UNMH (6th percentile) is likely a significant contributor to this problem. With the intent to improve patient satisfaction, our group aimed to identify and evaluate modifiable components of the meal experience as a first step in implementing simple, cost-effective interventions.

Methodology:

Anonymous surveys were created in RedCap and conducted electronically on 2-3 days per week over a 2-month period on two adult progressive care units at UNMH. Survey questions …

Physical And Emotional Pain Assessment In Outpatients Receiving Therapeutic Aphresis, D Sosnovske, C Reyes, M Prizzi, K Crookston, J Griggs, L Rosenbaum, J Huang, S Mertens, C Ornelas, M Santos, J Raval

Quality Improvement/Patient Safety Symposium

Purpose:

The Joint Commission has revised pain assessment standards and now requires health care entities to identify pain assessment as an organizational priority and monitor this data for hospitals, ambulatory care, and office-based procedures. However, assessments of pain in patients receiving therapeutic apheresis are currently lacking. In this prospective study, we queried our outpatients receiving therapeutic apheresis procedures to identify and characterize elements of both physical and emotional pain.

Methods:

In this prospective observational study, a pain assessment tool to address both physical and emotional pain was developed using elements of three validated pain assessment tools: the Wong-Baker FACES/Ten-Point Pain …

Geriatric Hip Fractures: Early Results Of A Multidisciplinary Approach, Edward Lu, Christopher Shultz, Sarah Burns

Quality Improvement/Patient Safety Symposium

Hip fractures are common in the elderly population and are a common cause of mortality. Hip fracture prognosis is poor and one-year mortality rates are between 20-30%. Current managements require expedient preoperative evaluation and clearance and recommend surgical intervention within 24-48 hours of presentation. Co-management services of elderly hip fracture have been shown to improve outcomes, reduce complications, and reduce healthcare costs. This study aims to analyze the co-management of elderly patient by orthopedic surgeons and internal medicine at the University of New Mexico Hospital. The aim of this quality improvement project was to decrease time between hip fracture diagnosis …

Establishing New Positive Ranges For Anti-Phospholipid Antibody Tests Based On The Local Population, Dennis Sosnovske, D G. Grenache, P Lowrey, D Rospopo, K Riley, R A. Marlar, M A. Rollins-Raval

Quality Improvement/Patient Safety Symposium

Introduction:

According to past and current guidelines from the International Society on Thrombosis and Hemostasis on the laboratory criteria for antiphospholipid antibody syndrome (APS), antiphospholipid antibody (anti-cardiolipin (aCL) and anti-beta2-glycoprotein 1 (aB2GP1)) concentrations are an integral component of the diagnostic criteria for APS. However, external quality control exercises have highlighted high variability between commercially available aCL and aB2GP1 assays. Due to lack of both international standards and common human monoclonal antibodies, guidelines recommend that test results be considered positive if greater than the 99th percentile of a particular population. The objective of this study was to determine the 99th percentile …

Longitudinal Assessments Using Validated Instruments In Myasthenia Gravis Outpatients Receiving Long-Term Therapeutic Plasma Exchange, Dennis Sosnovske, Chelsea Reyes, Margaret Prizzi, Kendall Crookston, Joseph Griggs, Lizabeth Rosenbaum, Jane Huang, Sarah Mertens, Cynthia Ornelas, Michon Santos, Jay S. Raval

Quality Improvement/Patient Safety Symposium

Purpose:

In the most recent American Society for Apheresis Guidelines on the Use of Therapeutic Apheresis in Clinical Practice, employing therapeutic plasma exchange (TPE) for long-term treatment of myasthenia gravis (MG) patients is a new indication and carries a category II, grade 2B recommendation. As data for this indication is evolving and subjective assessments of these patients are often uninformative, we sought to better characterize the impacts of long-term TPE in these MG patients using validated instruments.

Methods:

In this prospective observational study, we used a combination of validated instruments and openended questions clarifying concerns that are routinely applied to …

Expanding Hiv Screening In The Unmh Emergency Department, Zachary Pek, Tirajeh Saadatzadeh, Natalie Mariam Salas, Christopher G. Wilson, Charles Yaple, Carla Walraven, Preeyaporn Sarangarm, Cameron S. Crandall, Joy Crook, Dusadee Sarangarm, Amanda Stafford, Kimberly Page, Martha L. Carvour

Quality Improvement/Patient Safety Symposium

Introduction: Access to HIV screening and care may be limited in resource-constrained health care settings. The CDC recommends routine HIV screening for all patients aged 13-64 years, unless the prevalence of undiagnosed HIV in that population has been documented to be

New Mexico is ranked 34^th in the US for the rate of HIV diagnoses made per year—among the lowest of all 50 states. Meanwhile, NM is ranked 4^th for chlamydia, 22^nd for gonorrhea, and 20^th for syphilis [3]. This discrepancy in sexually transmitted infection rates suggests the possibility of underdiagnosis of HIV infection in NM …

Timely Screening Of Toddlers For Perinatal Hepatitis C Transmission, Leah F. Nelson, Sherry Weitzen, Sameul Baxley

Quality Improvement/Patient Safety Symposium

Introduction:

Approximately 5% of infants born to mothers with chronic Hepatitis C Virus (HCV) will acquire an vertically-transmitted infection. Untreated HCV in children can be devastating with onset of cirrhosis, fibrosis, and hepatocellular carcinoma within the first 15-20 years of life. Current national guidelines recommend delaying testing for HCV transmission until the infant reaches 18 months of age due to maternal antibody transfer. However, it is difficult to track the perinatal risk factor for 18 months during well-child care. The purpose of this project was to improve the process of tracking this exposure by increasing the use of the Problem …

The Use Of Weekly Podcasts As A Medium To Supplement Academic Internal Medicine Residency Didactics, Umar Malik, Krystal Chan, Matt Gerling, Jen Langsjoen

Quality Improvement/Patient Safety Symposium

INTRODUCTION:

The majority of resident physicians in the United States are from the Millennial Generation (born 1981 to 1996), currently aged 23 to 38 (1). It is estimated that 93% of Millennials have a smart phone (2). Podcasts represent almost 10% of audio listening among millennials (3), with the second-most preferred type of podcast among millennials being educational (28%) (4).

With this in mind, and in recognition of the demanding schedule of residents and interns on inpatient wards, the UNM Internal Medicine chief residents developed a podcast to supplement and reinforce the concepts taught in afternoon rounds on the inpatient …

Cqi Project Utilizing Pre-Transplant Frailty Assessment To Improve Transplant Outcomes, Rowan Al-Odat

Quality Improvement/Patient Safety Symposium

Background:

Frailty has long been recognized as a risk factor for prolonged hospitalization and discharge to skilled nursing facilities post general surgery in elderly patients (1). It has been shown that pre-operative rehabilitation programs can reduce length of stay and improve functionality post cardiothoracic surgery (2). In kidney transplant recipients, frailty is associated with 94% increased risk of delayed graft function (3) and 61% increased risk of early hospital readmission (4). In our center’s post-transplant population, we identified frailty as one of the factors that led to early mortality (within one-year post-transplantation) in two of our elderly patients.

CQI Project …

Increasing Dea-X Waiver Trained Providers Through Quality Improvement, Heather Metcalf, Sam Paltrow-Krulwich, Claire Sava, Kate Stanfield, Meagen Twyeffort, Ann Morrison, Vanessa Jacobsohn, Krystal Chan, Susarsri Prapasiri

Quality Improvement/Patient Safety Symposium

Introduction

New Mexico has long experienced challenges associated with opioid use disorder (OUD). In 2017, New Mexico had the seventeenth highest drug overdose death rate in the United States. Although this ranking has decreased since prior years, New Mexico experienced 16.7 overdose deaths involving opioids per 100,000 persons in 2017, compared to the national average of 14.6 per 100,000 persons. Additionally, New Mexico saw an 82% increase in opioid overdose related emergency department visits between 2013-2015, and this rate has stayed consistent since 2015.1 In 2017, of the 332 overdose deaths in New Mexico, the most common drugs causing overdose …

Fun With Control Charts: Monitoring Neoplastic Mutation Frequencies Over Time, Laura Toth, Teah Ruetschilling, Devon Chabot-Richards

Quality Improvement/Patient Safety Symposium

Introduction:

In order to ensure a laboratory assay is performing optimally and accurately results must be monitored over time. Per the College of American Pathologists (CAP) in general, for quality assurance purposes, results of any given assay must be reviewed monthly to assess for trends, outliers, and other possible problems to ensure timely investigation and/or remedy if needed. For molecular testing, choosing an appropriate method for monitoring can be difficult as the results of testing are not quantitative and the frequency of a positive finding may vary based of a patients clinical diagnosis and other demographic information.

Methods:

All result …

Sage Diagram Documentation In Burn Patients In New Mexico: Room For Quality Improvement, Mattalynn Chavez, Barkat Ali, Ryan Keffer, Victor Andujo, Whitney Elks, Sydney Cooper, Gregory Borah, Eugune Wu

Quality Improvement/Patient Safety Symposium

Objective

The first step in the management of burn patients is an accurate estimation of the body surface area. Based on percentage of body surface area involvement, burns are categorized as major (>20%) and minor (

Methods

This is a retrospective study of 327 consecutive patients from 2014-2018 at University of New Mexico Burn Center. Only patients undergoing surgical management were included. We recorded patient demographics, comorbidities, burn characteristics. The primary measure of interest was SAGE documentation and secondary measure of interest was outcomes associated with it.

Results

We found that SAGE diagram was completed on minority of patients …

Implementation Of A Shift Hand-Off Tool On The Va Psychiatric Ward, Hugo Gomez Rueda, Wayles E. Haynes, Ali Nakip, Samira Khalil, Dana Pinochotti

Quality Improvement/Patient Safety Symposium

INTRODUCTION:

The hand-off process is a common point of miscommunication which can compromise the quality of the provided clinical service and the safety of the patient. Currently, most Electronic Medical Records (EMR) software offers clinicians an embedded hand-off tool that allows clinicians to identify treatment plans, follow changes in patient care during shift transitions and address patient complications with efficiency. In this way, the most important information is communicated to on-coming teams and patient continuity of care is preserved. The Hands-Off Tool (H.O.T.) list on the Computerized Patient Record System (CPRS) EMR, can be used as an instrument to gather …

Truman Health Services Transitions In Care Clinic Quality Improvement Initiative, Quinn Jackson, Tracy M. Carlson, Lisette Infante, Lauretta England, Alan Saint, Natalie Mariam Salas

Quality Improvement/Patient Safety Symposium

Introduction:

Patients who are diagnosed with HIV but not retained in medical care have been identified as one of the highest risks for new HIV transmissions and have higher rates of all cause mortality ^1,2. Factors impacting retention in care include timely clinical follow up and timely prescription of anti-retroviral therapy³. We identified specific subpopulations among those living with HIV who are vulnerable to being lost to follow up, namely: patients newly diagnosed with HIV and patients transitioning across the healthcare system, such as those newly discharged from inpatient facilities ^4,5. We reviewed the processes for …

Process Improvement For Implementation Of A Verified Substance Use Screening Tool For All Patients In A General Medicine Inpatient Unit, Jera Davis, Dung Mac, Alexis Leyba, Alicia Meador, Cees Whisonant, Joanne Clinton, Loren Kelly, Charles Pizanis

Quality Improvement/Patient Safety Symposium

Introduction:

As of 2017, an estimated 21 million US adults, equivalent to 1 in 13 people, had a substance use disorder. Of those with a substance use disorder it was estimated that only 2.2 million received treatment. In 2015, New Mexico had the 8^th highest overdose death rate in the nation with the highest number of overall deaths attributed to Bernalillo County. The most common drugs used in overdose related deaths included heroin, benzodiazepines and prescription opioids. At the time of this study, it was found that the University of New Mexico Hospital did not have an identification tool …

Optimizing The Educational Value Of Surgical Morbidity And Mortality Conference, Rebecca Lynn Williams-Karnesky, Jorge Wernly, Erika Ketteler, M Tim Nelson, Jasmeet S. Paul, John C. Russell

Quality Improvement/Patient Safety Symposium

Introduction:

Weekly morbidity and mortality (M&M) conference has been a long-standing part of graduate surgical education in the United States. M&M conferences were established in the early 1900s as a tool for personal improvement. Since their inception, M&M conferences have focused on the presentation and discussion of cases which result in adverse outcomes for patients. The context in which healthcare is delivered has become increasingly complex, and training paradigms have changed, but the process of M&M has remained relatively unchanged. We sought to revise the weekly M&M conference in the Department of General Surgery in order to increase the educational …

Geriatric Hip Fracture Quality Initiative, K C. Helmig, C L. Shultz, S A. Mcarthur, R B. Blackstone, C Kurnik, M Wharton, D H. Chafey

Quality Improvement/Patient Safety Symposium

Introduction:

Multiple studies demonstrate increased morbidity, mortality, and loss of independence after hip fractures in geriatric patients. The 1-year mortality rate after a hip fracture has been estimated at anywhere from 14% to 58%. Hip fractures are one of the most common injuries evaluated by the UNM Orthopedic department. Geriatric hip fracture protocols have shown improved outcomes at many other centers with regard to improved functionality and decreased morbidity. The goal of this initiative is to improve outcomes with regard to length of hospital stay, functionality after surgery, and as a result, decreased morbidity and mortality.

Materials/methods:

All deaths in …

Impact Of A Bundle To Prevent Hysterectomy Surgical Site Infections, Yalda Barlas, Sydney Cooper, Marisa Griego, Sarina Pollat, Amber Lalla, Madeline Palmer, Mingma Sherpa, Niharika Ravichandran, Meghan Brett, Cara Ninivaggio

Quality Improvement/Patient Safety Symposium

Introduction:

In 2018, there were 2,943 surgical site infections (SSIs) among patients who underwent abdominal hysterectomies in the U.S. and these account for substantial morbidity and increased healthcare costs. University of New Mexico Hospitals (UNMH) has had elevated rates of abdominal hysterectomy SSIs compared with national benchmarks. One of these benchmarks includes the Standardized Infection Ratios (SIRs). UNMH’s SIR is often >1 indicating more infections than predicted. In response, a multidisciplinary team created and then implemented a bundle to prevent SSIs. Our objectives were to assess SSI bundle compliance and its impact on SSI rates and numbers.

Materials/Methods:

We collected …

Use Of Enhanced Recovery After Surgery (Eras) Protocol For Immediate Sub-Muscular Breast Reconstruction After Outpatient Mastectomy Is Safe And Significantly Reduces Costs, Ryan Kunkel, Audrey Rich, Venus Barlas, Stephanie Fine

Quality Improvement/Patient Safety Symposium

Introduction:

• ERAS protocols are associated with decreased postoperative stays, reduced opioid use, lower rates of postoperative nausea and vomiting, and lower overall costs to institutions and healthcare systems
• The aim of this study was to evaluate the impact of an ERAS approach on mastectomy with implant-based subpectoral reconstruction (IBR) with respect to procedure cost and 30-day complication rates for both ambulatory surgery patients and patients hospitalized overnight

Methods:

Study Type: Retrospective chart review analysis

Subjects: Patients over age 18 undergoing nipple-sparing mastectomy or skinsparing mastectomy with subpectoral IBR at a single institution.

Study Cohorts:

● ERAS: same-day surgery at an …

20200304_Come To Pubmed Now- Changes To The Interface, Kelleen Maluski

HSLIC Blog Post

No abstract provided.

03-02-2020 Hsc Committee Agenda (Revised V2), Hsc Committee

HSC Committee (A subcommittee of the UNM Board of Regents)

No abstract provided.

02-11-2020 Hsc Committee Minutes, Hsc Committee

HSC Committee (A subcommittee of the UNM Board of Regents)

No abstract provided.

Assessing And Expanding The Evidence Base For Project Echo And Echo-Like Models: Findings Of A Technical Expert Panel., Laura J Faherty, Adam J Rose, Andre Chappel, Caroline Taplin, Monique Martineau, Shira H Fischer

Project ECHO Bibliography

BACKGROUND: In 2003, Project ECHO (Extension for Community Healthcare Outcomes) began using technology-enabled collaborative models of care to help general practitioners in rural settings manage hepatitis C. Today, ECHO and ECHO-like models (EELM) have been applied to a variety of settings and health conditions, but the evidence base underlying EELM is thin, despite widespread enthusiasm for the model.

METHODS: In April 2018, a technical expert panel (TEP) meeting was convened to assess the current evidence base for EELM and identify ways to strengthen it.

RESULTS: TEP members identified four strategies for future implementors and evaluators of EELM to address key …

Evaluating Screening Participation, Follow-Up, And Outcomes For Breast, Cervical, And Colorectal Cancer In The Prospr Consortium, William E. Barlow, Elisabeth F. Beaber, Berta M. Geller, Aruna Kamineni, Yingye Zheng, Jennifer S. Haas, Chun R. Chao, Carolyn M. Rutter, Ann G. Zauber, Brian L. Sprague, Ethan A. Halm, Donald L. Weaver, Jessica Chubak, V Paul Doria-Rose, Sarah Kobrin, Tracy Onega, Virginia P. Quinn, Marilyn M. Schapira, Anna N A Tosteson, Douglas A. Corley, Celette Sugg Skinner, Mitchell D. Schnall, Katrina Armstrong, Cosette M. Wheeler, Michael J. Silverberg, Bijal A. Balasubramanian, Chyke A. Doubeni, Dale Mclerran, Jasmin A. Tiro

Pathology Research and Scholarship

BACKGROUND: Cancer screening is a complex process encompassing risk assessment, the initial screening examination, diagnostic evaluation, and treatment of cancer precursors or early cancers. Metrics that enable comparisons across different screening targets are needed. We present population-based screening metrics for breast, cervical, and colorectal cancers for nine sites participating in the Population-based Research Optimizing Screening through Personalized Regimens consortium.

METHODS: We describe how selected metrics map to a trans-organ conceptual model of the screening process. For each cancer type, we calculated calendar year 2013 metrics for the screen-eligible target population (breast: ages 40-74 years; cervical: ages 21-64 years; colorectal: ages …

Transfusion Of Uncrossmatched Group O Erythrocyte-Containing Products Does Not Interfere With Most Abo Typings, Mark H. Yazer, Philip C. Spinella, Leilani Doyle, Richard M. Kaufman, Robyn Dunn, John R. Hess, Luiz Amorim Filho, Magali Fontaine, Birgit Gathof, Bryon Jackson, Michael F Murphy, Jeremiah Pasion, Jay S. Raval, Kristin Rosinski, Jansen Seheult, Andrew W. Shih, Jason Sperry, Julie Staves, Erin E. Tuott, Alyssa Ziman, Darrell J. Triulzi

Pathology Research and Scholarship

BACKGROUND: Group O erythrocytes and/or whole blood are used for urgent transfusions in patients of unknown blood type. This study investigated the impact of transfusing increasing numbers of uncrossmatched type O products on the recipient's first in-hospital ABO type.

METHODS: This was a retrospective cohort study. Results of the first ABO type obtained in adult, non-type O recipients (i.e., types A, B, AB) after receiving at least one unit of uncrossmatched type O erythrocyte-containing product(s) for any bleeding etiology were analyzed along with the number of uncrossmatched type O erythrocyte-containing products administered in the prehospital and/or in hospital setting before …

Sclerosing Epithelioid Mesenchymal Neoplasm Of The Pancreas - A Proposed New Entity, Olca Basturk, Britta Weigelt, Volkan Adsay, Jamal K Benhamida, Gokce Askan, Lu Wang, Maria E. Arcila, Giuseppe Zamboni, Noriyoshi Fukushima, Rodrigo Gularte-Mérida, Arnaud Da Cruz Paula, Pier Selenica, Rahul Kumar, Fresia Pareja, Christopher A. Maher, John Scholes, Yoshinao Oda, Donatella Santini, Leona A. Doyle, Iver Petersen, Uta Flucke, Christian Koelsche, Samuel J. Reynolds, Aslihan Yavas, Andreas Von Deimling, Jorge S. Reis-Filho, David S. Klimstra

Pathology Research and Scholarship

We have encountered pancreatic tumors with unique histologic features, which do not conform to any of the known tumors of the pancreas or other anatomical sites. We aimed to define their clinicopathologic features and whether they are characterized by recurrent molecular signatures. Eight cases were identified; studied histologically and by immunohistochemistry. Selected cases were also subjected to whole-exome sequencing (WES; n = 4), RNA-sequencing (n = 6), Archer FusionPlex assay (n = 5), methylation profiling using the Illumina MethylationEPIC (850k) array platform (n = 6), and TERT promoter sequencing (n = 5). Six neoplasms occurred in females. The mean age …

Hobnail Cells In Encapsulated Papillary Thyroid Carcinoma: Report Of 2 Cases With Immunohistochemical And Molecular Findings And Literature Analysis, Shweta Agarwal, Qandeel Sadiq, Ibrahim Ortanca

Pathology Research and Scholarship

Papillary thyroid carcinoma (PTC) is the most common malignant tumor of the thyroid gland with most tumors behaving in an indolent fashion. However, morphologic variants have been described, such as tall cell, diffuse sclerosing, columnar cell etc. which are biologically more aggressive. One of these variants includes the more recently described hobnail variant (HVPTC) which shows micropapillae and presence of large cells with apically placed hyperchromatic nuclei, reverse polarity, and eosinophilic cytoplasm, akin to hobnail cells. The presence of >30% hobnail cells in a PTC deserves categorization as a hobnail variant. This variant is usually associated with extra thyroidal extension, …

Drug Resistance Of Previously Treated Tuberculosis Patients With Diabetes Mellitus In Shandong, China, Wan-Mei Song, Yi-Fan Li, Jin-Yue Liu, Ning-Ning Tao, Yao Liu, Qian-Yun Zhang, Ting-Ting Xu, Shi-Jin Li, Qi-Qi An, Si-Qi Liu, Chun-Bao Yu, Lei Gao, Cui-Xiang Yu, Min Zhang, Huai-Chen Li

Pathology Research and Scholarship

BACKGROUND: Although the association between diabetes mellitus (DM) and tuberculosis (TB) has been well-documented for centuries, evidence of the link between diabetes and drug resistance among previously treated TB patients remains limited and inconsistent.

METHODS: An observational study was performed that involved 1791 retreated TB-no DM patients (refers to TB cases without diabetes) and 93 retreated TB-DM patients (refers to TB cases with diabetes) in Shandong, China from 2004 to 2017. Baseline data including demographic and clinical characteristics, drug susceptibility test (DST) results, and diabetes status were collected. Categorical baseline characteristics were compared by Fisher's exact or Pearson Chi-square test. …

Protocols, Practices, And Needs For Investigating Sudden Unexpected Infant Deaths, Carri Cottengim, Sharyn Parks, Dale Rhoda, Tom Andrew, Kurt B. Nolte, John Fudenberg, Mary Ann Sens, Jennifer Brustrom, Betsy Payn, Carrie K. Shapiro-Mendoza

Pathology Research and Scholarship

Understanding case identification practices, protocols, and training needs of medical examiners and coroners (MEC) may inform efforts to improve cause-of-death certification. We surveyed a U.S.-representative sample of MECs and described investigation practices and protocols used in certifying sudden unexpected infant deaths (SUID). We also identified MEC training and resource needs. Of the 377 respondents, use of the SUID Investigation Reporting Form or an equivalent was 89% for large, 87% for medium, and 52% for small jurisdictions. Routine completion of infant medical history, witness interviews, autopsy, photos or videos, and family social history for infant death investigations was ≥80%, but routine …

Coalition For Prisoners' Rights Newsletter, Vol 45-B, No. 3, Coalition For Prisoners' Rights

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Helpful to Know About Coronavirus

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