Digital Commons Network^™

The Effects Of A Surrogate Provider System For Asynchronous Computerized Notifications Of Test Results In A Primary Care Resident Clinic, Michael Louie, Luke Yeager, Angela Dunn

Quality Improvement/Patient Safety Symposium

With the use of Electronic Medical Records (EMRs), there is a growing concern for the quality and safety of patient care among the sheer volume of information distributed and processed daily. Within the Veteran Affairs (VA) system, 37% of primary care providers report at least one patient missed test result within the previous two weeks leading to a diagnostic delay (Wahls and Cram 2007). Termed “view alerts,” these computerized notifications are the primary way information such as test results or nursing concerns are conveyed to the provider asynchronously. One study showed that VA providers received 58 “view alerts” per day …

Providing High Reliability Care For Picu Patients With Pulmonary Hypertension: A Quality Improvement Project, Anjali Subbaswamy, Nicholas Tan, Iric Guthrie, Kelsey Fath, Cole Linzmeyer, Elizabeth Yakes Jimenez

Quality Improvement/Patient Safety Symposium

Providing High Reliability Care for PICU Patients with Pulmonary Hypertension: A Quality Improvement Project

Anjali Subbaswamy, MD; Nicholas Tan, DO; Iric Guthrie, MD; Kelsey Fath, MD; Cole Linzmeyer, DO; Elizabeth Yakes Jimenez, PhD, RDN, LD

Purpose: Pediatric patients with pulmonary hypertension (PHTN) are a high acuity, low frequency population, and are often admitted to the pediatric intensive care unit (PICU). To mitigate the risk of precipitating a potentially life-threatening pulmonary hypertensive crisis, health care staff need to take specific precautions. This quality improvement (QI) project aims to increase the number of inpatient PHTN patients for whom PHTN precautions are applied …

Improving Pneumococcal Vaccination Adherence In Eligible Candidates Over 65 Years Of Age Per Uspft Guidelines At Westside Clinic, Meredith Keller, Ashley Wildman, Julia Howard, Leland Abrams, Erika Jones

Quality Improvement/Patient Safety Symposium

Background

Pneumococcal polysaccharide vaccine (PPSV23) is recommended to all adults 65 years and older, people 2 through 64 years with certain medical conditions and all adults older than 19 years who smoke. This vaccine prevents severe pneumococcal disease, reducing hospital admissions and risk of death. As part of a quality improvement project, a group Internal Medicine resident physicians with continuity clinic at the UNMH Westside Clinic sought to increase our vaccinations rates with PPSV23 in patients older than 65 years.

Methods

A list of 282 patients aged 65 or older receiving primary care at the UNMH Westside Clinic were identified …

Inpatient Prescription Drug Monitoring Program Usage At Unmh: A Pilot Qi Proposal To Decrease Prescription Opioid Misuse, Sally Midani Bs, Isabella Cervantes Ba, Isaac Lira Bs, Krista Dominguez-Salazar Pharmd, Phc3, Adriana R. Carrillo Pharmd, Sergio Huerta Md

Quality Improvement/Patient Safety Symposium

Opioid overdose is a worldwide epidemic, claiming the lives of almost 450,000 people from 1999-2018. Studies show that this number might be even higher, with an estimated 130 people dying daily from prescription opioid overdose as a staggering 11.4 million people currently misuse these potent medications. The implementation of state-based Prescription Drug Monitoring Programs (PDMP) has increased in recent years and may be responsible for the significant decrease in prescription opioid involved death rates in 2018, a 13.5% decline. The PDMP functions as a live online database where a patient’s prescription fill date, medication name, strength, supply, pharmacy and prescriber …

Patient Satisfaction While Receiving High-Risk Obstetrics Care Via Telemedicine During Sars-Cov-2 Pandemic, Remy Link, Eliana Garcia, Rachel Ruckman, Jaquelyn Blackstone, Vivek Katukuri, Luis Izquierdo

Quality Improvement/Patient Safety Symposium

Patient satisfaction while receiving high risk Obstetrics care via telemedicine during SARS-COV-2 Pandemic

Aim: The SARS- COV-2 pandemic has drastically changed the way healthcare providers deliver care to both obstetric and non-obstetric patients. Pregnant women have a higher risk of developing complications from viral infections, such as SARS-COV-2. As the use of telemedicine for prenatal care increases, the impact of telehealth on underserved patients is unclear. The primary aim of our study is to understand how providing telemedicine care during SARS-COV-2 has affected patient satisfaction and overall patient experience in pregnant women receiving care in New Mexico.

Methods: This qualitative …

Using Smartsheet To Track, Support, And Document Resident Qi Activities, Tim Petersen Phd, Laura Pinault Md, Terra Wubbenhorst Md, Jack Srouji, Tony Yen Md

Quality Improvement/Patient Safety Symposium

In early 2020, personnel involved with the Anesthesiology Department’s quality assurance, residency, and research programs convened in an effort to address two pressing concerns. One of these was that Quality Improvement (QI) activities by residents had a tendency to begin well, with real enthusiasm and smooth progress, but then gradually lose priority as the pressures and obligations of residency won out. Another was the ACGME’s announcement that it would begin expecting more documentation of residents’ significant involvement in QI. The department needed a way to ensure both progress and documentation.

The group settled on a solution involving the creation of …

Antibiotic Use For Children In The Picu With Severe Viral Bronchiolitis, Anjali Subbaswamy, Elizabeth Yakes Jimenez

Quality Improvement/Patient Safety Symposium

Antibiotic use for children in the PICU with severe viral bronchiolitis Anjali Subbaswamy, MD; Chelsea Sanchez, MD; Claire Zeorlin, MD; Elizabeth Yakes Jimenez, PhD, RDN, LD

BACKGROUND: Viral bronchiolitis is not treated with antibiotics, but with supportive care. Antibiotics may be used for secondary bacterial pneumonia, which is difficult to diagnose in small children. Children with severe bronchiolitis are admitted to the PICU, and often receive empiric antibiotics.

OBJECTIVES: To examine clinical factors associated with systemic antibiotic use in severe bronchiolitis based on retrospective chart review of PICU patients.

METHODS: We identified children discharged from the UNMH PICU from January …

Paracentesis Complications, Kristen Baca, Hannah Howse, Jacob Imber, Deepti Rao, Anthony Worsham

Quality Improvement/Patient Safety Symposium

Background/Introduction Paracentesis is considered relatively safe when performed therapeutically or diagnostically for patients with ascites. In spite of that safety, complications are still possible as with all procedures. Recent literature shows that deep circumflex artery injuries have been an underreported complication of paracentesis due to anatomical variants in patients with distended abdominal cavities. We note that most of the literature about complications has been done in an outpatient population, not an inpatient population. We are conducting chart reviews to identify if arterial injuries and other complications are present within our inpatient population and to determine if paracentesis procedures have a …

A Provider-Facing Dashboard To Monitor Hydroxychloroquine Dosing Within The Va Healthcare System: The Albuquerque Va Experience, Meredith Keller, David Cisneros, Kimberly Reiter, Gabriela Schmajuk

Quality Improvement/Patient Safety Symposium

Monitoring hydroxychloroquine dosages to avoid retinal toxicity in patients within the VA Healthcare System, a multi-site study

Background

Through the SFVA Measurement Science QUERI led by Principle Investigator Gabriela Schmajuk MD, the Albuquerque VA Healthcare System was enrolled in a multi-site study to identify patients with hydroxychloroquine doses greater than the recommended 5mg/kg to reduce the risk of retinal toxicity.

Methods

Using the Dashboard tool, patients with hydroxychloroquine doses greater than 5mg/kg were identified. Data about these patients, including weight, rheumatologic diagnoses, dosages, and prescribing providers was collected. The prescribing providers were then contacted with dosage recommendations.

Results or expected …

The Role Of Comorbidities And Social Determinants Of Health In Patients With Covid-19 In New Mexico, Lauren Epler, Tenzin Desel, Ariana Thompson, Samantha Paltrow-Krulwich, Susie Pham, Diamone Gathers Md, Krystal Chan Md

Quality Improvement/Patient Safety Symposium

Introduction

Comorbidities are associated with higher levels of morbidity and mortality in patients with COVID-19 infection. Minorities have been disproportionately affected by COVID-19. Additionally, minorities have high rates of comorbidities.

Methods

Students surveyed consented patients on RedCap who tested positive for COVID-19 infection and were seen in the UNM COVID-Follow up Clinic between April-October 2020 via telephone.

Results

125 patients. 52% Hispanic/Latino, 23% American Indian/Alaska Native, 16% white, 3% African American, 1% Asian, and 5% multiple race/ethnicities. 16% had vaped nicotine, 15% had vaped marijuana or cannabis, and 33% had smoked at least 100 cigarettes in their lifetime. 23% had …

Implementation Of Minimal Erythema Dose Testing To Optimize Phototherapy Delivery, Catherine N. Tchanque-Fossuo, Melanie T. Garcia, Adam W. Crosby, Taylor Thomas, Therese Holguin

Quality Improvement/Patient Safety Symposium

Background/Introduction

Phototherapy is a safe and effective treatment modality for numerous common and uncommon dermatologic conditions in children and adult population.^1,2 Most phototherapy protocols use non-ionizing ultraviolet (UV) radiation of different wavelengths, such as broadband UVB (290-320 nm), narrowband UVB (311-313 nm), 308 nm excimer laser, UVA 1 (340-400 nm), UVA with psoralen (PUVA), and extracorporeal photochemotherapy (photopheresis).³ Dermatoses that may benefit from artificial UV light phototherapy include psoriasis, atopic dermatitis/eczema, generalized pruritus, cutaneous T-cell lymphoma, morphea, vitiligo.^1,2,4-8

This is particularly relevant to the University of New Mexico Hospital, which houses one phototherapy booth at the Department …

Anal Cancer Screening At Truman Health Services, Peter D. Tran, Harshdeep Babbar

Quality Improvement/Patient Safety Symposium

Anal Papanicoloau Screening at Truman Clinic

Anal cancer is a squamous cell cancer associated with human papillomavirus (HPV), the same virus that is associated with cervical cancer. Although vaccination against HPV has been shown to be effective in reducing overall rates of infection, the number of new anal cancer cases has been rising for many years. In HIV-infected men and women, the incidence is even higher of anal cancer than in the general population. Current rates in an HIV-infected MSM population have been estimated to be as high as 70-144 per 100,000, with some studies of HIV-infected individuals showing that …

Communication In Interventional Radiology: Addressing The Challenges Of Complexity And The Impact Of Secure Text-Message Communications, Aakriti Mishra, Daniel Harwood, William Schaeffer, Anna Fabre, Emily Ochmanek, Paul Vantine, Sean Biggs, Ryan Lebaron

Quality Improvement/Patient Safety Symposium

Background: The utilization of smartphone-based technology to improve multidisciplinary communication and patient care provides an exciting opportunity for quality improvement research. In our institution, consult requests have traditionally been responded to verbally, in person or over the phone. Unfortunately, this is prone to communication errors and duplication of work. Approximately three years ago, our division developed a uniform consultation note that could easily be placed in the patient record. Additionally, we analyze the impact of a HIPAA compliant messaging system (“Tiger Connect™”) on communication inside and outside the interventional radiology (IR) department.

Methods and materials: The electronic health record (EHR) …

Enhanced Arthrocentesis Of The Flexed Knee With Pneumatic Compression, Sumir Brahmbhatt, Maheswari Muruganandam, Ahsan Iqbal, David Cisneros, Adnan Kiani, Nicole Suzanne Emil, Sharon Nunez, William Hayward, Philip Band, Wilmer Sibbitt Jr.

Quality Improvement/Patient Safety Symposium

Background/Objective: To explore an alternative to standard extended knee arthrocentesis using pneumatic compression of the flexed knee.

Methods: Using a paired sample design, 41 consecutive effusive knees underwent arthrocentesis in the flexed knee position first without and then with pneumatic compression of suprapatellar bursa. Arthrocentesis success and fluid yield in milliliters (ml) were measured. For comparison 41 consecutive patients who had undergone extended knee arthrocentesis without and with compression were also studied.

Results: Successful diagnostic arthrocentesis (≥ 3 ml) of the effusive flexed knee was 85% (35/41) without compression and increased significantly to 100% (41/41) with pneumatic compression (p=0.027). Synovial …

A Retrospective Study Tracking Patient Outcomes For The Unmh Pediatric Ed Home Oxygen Pathway For Bronchiolitis Patients, Molly Johnson, Jennifer Thompson, Adinda Demske, Rachel King, Rachel Tuuri, Kjirsten Swenson

Quality Improvement/Patient Safety Symposium

Introduction:

Bronchiolitis, a lower respiratory tract infection that predominantly affects infants and children younger than two years of age during the fall and winter months, has been shown to be a leading cause of hospitalization for children younger than 5 years of age. This disease process takes on both severe and non-severe forms with evidence that outpatient treatment for the non-severe form is optimal and desirable for patients. Factors that predict mild disease without need for high flow nasal cannula, intensive care unit, non-invasive ventilation and intubation include: >2 months old, oxygen saturation ≥ 90%, no nasal flaring, no grunting, …

20210521_Hslic Welcomes George Hernandez, Sally Bowler-Hill

HSLIC Blog Post

No abstract provided.

Pediatric Residency Academic Rotation Improves Self-Rated Proficiency In Quality Improvement Skills, Maria Heubeck, Rebecca Craig, Taylor Ford, Lanier Lopez, Grace Mccauley, Elizabeth Yakes Jimenez

Quality Improvement/Patient Safety Symposium

Category: In-progress research

Title: Pediatric Residency Academic Rotation Improves Self-Rated Proficiency in Quality Improvement Skills

Maria Heubeck, MD; Rebecca Craig, MD; Taylor, Ford, MD; Lanier Lopez, MD; Grace McCauley, MPH; Elizabeth Yakes Jimenez, PhD, RDN, LD

Introduction: As of July 2020, all second-year pediatric residents participate in a one-month academic rotation. The rotation focuses on quality improvement (QI), research, education and leadership skills and experience. This project aims to assess the impact of the rotation on residents’ self-reported QI proficiency, self-rated motivation to pursue scholarly activities, and competency based on ACGME milestones.

Methods: Pediatric residents participating in the academic rotation …

Present Anesthesiology Practices In The Context Of Patent Foramen Ovale: Pfo Anesthesiology Survey, Hank M. Spellman Ms, Huynh (Wendy) Nguyen Md, Ricardo Falcon Md, Tim Petersen Phd, Codruta Soneru Md

Quality Improvement/Patient Safety Symposium

Institutions around the US often have no defined standard of care (SOC) measures concerning perioperative management of posterior spinal fusion (PSF) surgery patients with a patent foramen ovale (PFO). There is a tacit risk for paradoxical air embolism (PAI) for patients who undergo PSF (1,2,3). The sequelae of PAI include stroke, myocardial infarction, splanchnic infarction, cardiovascular collapse, and death. Upon IRB approval of our survey, data was gathered from 350 pediatric anesthesiologists. There were 49 responses; 46 of whom completed the survey. 81% of respondents practice in surgical settings and 92% provide anesthesia for PSF. 63% had 10-years or more …

20210520_Global Accessibility Day, Kelleen Maluski

HSLIC Blog Post

No abstract provided.

Memory Care Approaches To Better Leverage Capacity Of Dementia Specialists: A Narrative Synthesis, Jenny Lam, Soeren Mattke

Project ECHO Bibliography

Prior research suggests that a scarcity of dementia specialists could hamper access to disease-modifying Alzheimer’s treatments. We describe alternative approaches on how to leverage specialist time for memory care in this narrative synthesis based on 17 semi-structured interviews and a targeted literature review on memory care approaches that leverage specialist time. We identified four types of approaches: community primary care practices empowered with better tools and training; primary care memory clinics; specialty memory clinics and; specialty memory centers. Several approaches to use specialist time efficiently have been implemented and some but not all evaluated. The optimal approach may depend on …

Efficacy Of As04-Adjuvanted Vaccine Against Human Papillomavirus (Hpv) Types 16 And 18 In Clearing Incident Hpv Infections: Pooled Analysis Of Data From The Costa Rica Vaccine Trial And The Patricia Study, Joseph E. Tota, Frank Struyf, Allan Hildesheim, Paula Gonzalez, Martin Ryser, Rolando Herrero, John Schussler, Naveen Karkada, Ana Cecilia Rodriguez, Nicolas Folschweiller, Carolina Porras, Mark Schiffman, John T. Schiller, Wim Quint, Aimée R. Kreimer, Matti Lehtinen, Cosette M. Wheeler, Joshua N Sampson

Pathology Research and Scholarship

Clinical trial data and real-world evidence suggest that the AS04-adjuvanted vaccine targeting human papillomavirus types 16 and 18 (AS04-HPV-16/18) vaccine provides nearly 90% protection against cervical intraepithelial neoplasia grade 3 or higher irrespective of type, among women vaccinated before sexual debut. This high efficacy is not fully explained by cross-protection. Although AS04-HPV-16/18 vaccination does not affect clearance of prevalent infections, it may accelerate clearance of newly acquired infections. We pooled data from 2 large-scale randomized controlled trials to evaluate efficacy of the AS04-HPV-16/18 vaccine against clearance of nontargeted incident infections. Results of our analysis do not suggest an effect in …

Are Only The Unskilled Overconfident? Deconstructing The Dunning-Kruger Effect Through An Individual Differences Approach, Danielle N. Sanchez

Psychology ETDs

This study sought to determine whether individuals suffering from the Dunning-Kruger effect are prone to misassessing their performance due to underlying personality and cognitive characteristics. To test this hypothesis, we first collected theory-informed measures of cognitive and personality traits. Next, we used three different performance estimate measures to assess the degree to which participants misestimated their abilities across two performance tasks (e.g., English grammar and logical reasoning). We found that some individuals are more prone to misassessing their performance and self-reported general Metacognitive Ability, Openness to Experience from the Big-Five personality Inventory, and an External Locus of Control orientation can …

20210518_Asian Pacific American Heritage Month & Action From The Health Sciences Library, Kelleen Maluski

HSLIC Blog Post

No abstract provided.

Iina Dziil Be’At’Iin (On The Path Of A Strong Life): Dine (Navajo) Perceptions Of Self-Care And Social Support With Diabetes Management, Chenoa Bah Stilwell-Jensen

Communication ETDs

ABSTRACT

Managing diabetes requires a detailed self-care regimen of physical activity, eating well, testing glucose, healthy weight maintenance, and positive emotional outlook in order to maintain health outcomes. Education, clear communication, and sufficient support are needed to address challenging aspects of daily self-care at the onset of diagnosis and throughout the management of the illness. However, many people diagnosed with diabetes are unable to successfully manage their condition. Native Americans are twice as likely to have diabetes than Whites. Although diabetes-related kidney failure and other negative health effects remain a concern among Native Americans, rates of kidney failure in this …

Satisfaction And Willingness To Recommend: Patient Experience In A Southwestern Healthcare Organization, Judy A. Sanchez

Nursing ETDs

This descriptive study examined perceptions of hospital care in a minority majority state within adult Hispanic white, American Indian, and non-Hispanic white patients using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This secondary analysis of de-identified 2016-2018 data involved 10,181 patients discharged from two urban and five rural hospitals. Demographic variables included: race/ethnicity, preferred language, and hospital location. HCAHPS variables included: overall satisfaction, willingness to recommend, nurse communication, physician communication, responsiveness of hospital staff, pain management, medication communication, cleanliness and quietness, discharge information, and transition of care. Chi-square and loglinear analyses demonstrated that Hispanic whites, and …

Unm Hslic Organizational Chart 2021, Sally Bowler-Hill

HSLIC Organizational Charts

No abstract provided.

Exploring The Role Of Core Positive Selves With Men Convicted Of Child Sexual Offenses: A Character Strengths Initiative, Tiffany A. Miner

Individual, Family, and Community Education ETDs

The aim of this study was to help men convicted of child sexual offenses learn to recognize and engage their character strengths over 12 months. Participants were six men convicted of contact and noncontact (internet) child sexual offenses. All participants were members of a community-based reintegration group for registered citizens. In the first weeks of the study, participants received the Values in Action Inventory of Strengths survey. The survey, containing 240 questions—10 items for each of the 24 character strengths outlined—helped participants identify their top character strengths. The study explored (a) how the men could use their character strengths to …

20210517_Hslic's Biomedical Informatics Seminar Series Presents- Mary Hill, Mot, Otr.L & Ingrid Hendrix, Mils, Ahip, Tamara Wheeler

HSLIC Blog Post

No abstract provided.

The Impacts Of Disturbance On Submerged Aquatic Macrophytes Populations Of The Jemez Mountains, New Mexico, Virginia Frances Thompson

Biology ETDs

This dissertation investigates the effects of disturbance (a catastrophic forest fire and decadal-level multi-day flood) on populations of submerged aquatic macrophytes (SAMs) in the streams and rivers of the Jemez Mountains of northern New Mexico, USA. Research conducted and reported in this dissertation addresses the following research questions: 1.) What factors influence the presence or absence of SAMs in Jemez Mountain streams? 2.) How does disturbance (catastrophic wildfire and decadal-level flood) change the amount of aboveground SAM biomass? and 3.) How does that disturbance change the nutrient content (%C, %N, %P) and nutrient stoichiometry of SAMs? These disturbance events had …

Health Impacts Of Wildfire Smoke As A Consequence Of Climate Change And Recommendations For Public Health Officials And The General Public In The Albuquerque Metropolitan Area, Jegason Diviant

Climate Change and Public Health Preparedness

No abstract provided.