Medicine and Health Sciences Commons^™

Scrubs Tracking, Michael Saris

Health Equity and Quality Improvement (HEQI) Summit

The DICE Group repurposed an ID badge scanning app originally built for OIA to enable scrubs to be checked out then checked back in, therefore enforcing rationing limits.

John Covid-19 Employee Exposure Tracking, Michael Saris

Health Equity and Quality Improvement (HEQI) Summit

We iteratively built a data entry and dashboarding platform that has enabled JOHN to track over 2,500 employees exposed to COVID-19 or at high risk of exposure to COVID-19.

Covid-19 Student Telehealth Support Initiative, Yash Varma, Mary White, Alexandra Leto

Health Equity and Quality Improvement (HEQI) Summit

SKMC students partnered with numerous TJUH departments and developed a telehealth support initiative to:

• Help TJUH patients navigate the telehealth system
• Reduce system-wide appointment delays experienced by patients
• Provide direction to COVID-19 resources

A Volunteer Script was prepared to help patients troubleshoot common issues with accessing the telehealth system and provide up to date recommendations from the CDC to remain safe.

Twilighter Role To Support Primary Team Patient Care, Workflow Efficiency, And Physician Wellbeing, Jesse Edwards, René Daniel, Catriona Harrop

Health Equity and Quality Improvement (HEQI) Summit

Objective

Enhance patient care, process efficiency, and physician wellbeing by decompressing primary team workload and reducing the multitasking demands during critical hours of the daily workflow

Ventilator Decision And Allocation Pathway For Surge Conditions, Bridget Gekas, Jerin Juby, Monica Purcell, John Smith, Laura Fantazzi, Raymond Malloy

Health Equity and Quality Improvement (HEQI) Summit

We created a deployment plan of the available ventilator fleet to be deployed during surge conditions. The plan includes appropriate allocation of acute care ventilators to manage complex respiratory patients, while a percentage of stable respiratory patients can be safely managed using a back-up ventilator.

Organizing A System-Wide Effort On Ventilator Supply Management During Covid-19, Jerin Juby, Raymond Malloy, Bridget Gekas, Laura Fantazzi, Monica Purcell, John Smith, Kathryn Sebastian, Lauren Diduch, Melissa Brancolassi, Megan Hennessy, James Fields

Health Equity and Quality Improvement (HEQI) Summit

We developed a concise definition of ventilators to accurately represent them in all reports across the enterprise, and a ventilator deployment plan.

Use Of Mobility And Exercise Videos During Covid-19 To Minimize Deconditioning, Nethra Ankam, Md, Tulasi Gude, Md, Courtney Back, Pt, Monina Florendo, Pt, Elizabeth Hearn, Pt, Morgan Miller, Pt, Kristen Stout, Pt

Health Equity and Quality Improvement (HEQI) Summit

COVID19 patients are at risk for becoming quickly deconditioned, especially in the hospital setting given the nature of the virus and those that get admitted. The concern for deconditioning stems from patients being confined to their room, the need to minimize exposure amongst healthcare providers and the need to conserve PPE.

We wanted to find ways to optimize opportunities for patient mobility, maintain patient and provider safety, all while conserving PPE. We reviewed the Chinese Association of Rehabilitation Medicine guidelines to help develop the exercise program.

Meeting The Critical Need For Ventilators In Treatment Of Covid-19 Patients, Alessandro Naopli, Nicholas Satterthwaite, Lawrence Husick, Dietrich Gravenstein, Jerin Juby, Monica Purcell, Bridget Gekas, Zvi Grunwald, Mae West, Bon Ku, Chip Malloy, Michael Mahla, Mijail Serruya

Health Equity and Quality Improvement (HEQI) Summit

We have designed and built a microprocessor-controlled valve manifold having a single air input supplied from a standard ventilator, three air outlets (one per patient), and a digital control panel for setting the pressure supplied to each patient as well as the desired respiration rate. The manifold features multiple pressure sensors for system monitoring. Each inspiration limb of the manifold will be fitted with a viral filter. Each expiration limb will have a passive HME in line with a viral filter to prevent patient cross-contamination and spread of virions.

Each patient will receive one epoch of inspiration pressure followed by …

#Team-Based Approach To Sedation Management In Patients With Sars Cov-2 Aka Covid-19 In The Medical Icu, Hadiatou Barry, Md, Mph, Franklin Thelmo, Do, Atsoufi Amewuame-Kpehor, Md

Health Equity and Quality Improvement (HEQI) Summit

The COVID-19 pandemic has led to a proliferation of patients developing ARDS and requiring prolonged supportive care on mechanical ventilation. As a result, patients need elevated levels of sedation, often on multiple agents for a period greater than typically seen in an ICU population. As a result of this high sedation phenomenon, patients are developing higher rates of expected complications including severe constipation, neurocognitive delay, ICU myopathy, poor sedation weaning, and high pain control requirements. These complications lead to an increased rate of mortality in a population that is already very high and decreases the rate of successful extubation and …

Creation Of A Dedicated Anesthesia Airway Cart For Use In High-Volume Covid-19 Airway Management, Anna Rabinowitz, Alexander M. Olson, Daniel Casey, Elaine Kilmartin

Health Equity and Quality Improvement (HEQI) Summit

The COVID-19-specific approach to intubation required a change in the team structure and workflow for emergent airway management.

1. New need for bulky PPE and the introduction of an aerosol barrier shield for emergent intubations
2. Higher volume of intubations and use of videolaryngoscopy requires additional equipment
3. Concern for Code Cart contamination and wastage of airway equipment
4. Desire for more efficient approach to selecting and customizing equipment

Repairing A Damaged Powered Air-Purifying Respirator (Papr) Battery Component Component With 3-D Printing, Robert Ries, Dante Varotsis, Michelle Ho, Kathryn Linder, Jordan Kurzum, Bon Ku, Md, Mpp, Matt Fields, Md, Robert Pugliese, Pharmd, Morgan Hutchinson, Md

Health Equity and Quality Improvement (HEQI) Summit

• A team from the Thomas Jefferson University Health Design Lab worked with local engineers at FKB to create a 3-D replacement model for the faulty component
• A new component was designed to function with existing battery components
• The new component was created using a desktop fused deposition modeling (FDM) 3-D printer with polylactic acid (PLA) filament

Increasing Polst Documentation For Patient Transfers From Long Term Care Facilities, Jennifer White, Md, Mari Siegel, Chris Haines, Chris Pitsch, Heather Peiritsch, Erica Westlake

Health Equity and Quality Improvement (HEQI) Summit

With an increase in patients from long term care facilities being admitted to the hospital, a lack of goals of care documentation became evident and presented the providers with many unknowns regarding patient care.

Without documentation and sick with COVID, patients cannot always advocate for themselves. This problem is worsened by the ban on visitors, preventing surrogate decision makers from being in the room.

There is a need for providers at long term care facilities to have these goals of care discussions, for COVID specific circumstances and for long term care.

Telemedicine Certified Recovery Specialists For Patients With Opioid Use Disorders In The Emergency Department In Covid-19, Kory S. London, Md

Health Equity and Quality Improvement (HEQI) Summit

COVID-19 is a staggering tragedy in a number of manners, but the lack of available access points to healthcare services due to federal, state, local and institutional regulations and decisions creates higher levels of patient vulnerability.

Patients with opioid use disorders (OUD) are especially vulnerable given high levels of coexistent housing insecurity, food insecurity and lack of primary care at baseline. These patients frequently utilize the emergency department for both medical and non-medical concerns.

Existing pathways to assist these patients utilize in person certified (peer) recovery specialists (CRS) who are not employed by the enterprise. Given the need to limit …

Disposable Equipment For Efficient Home Sleep Apnea Testing And Minimizing Human Handling At The Sleep Laboratory, Abigail Quintos, Robert Tavella, Karl Doghramji

Health Equity and Quality Improvement (HEQI) Summit

As part of the disease mitigation strategy at the time of the pandemic, the Jefferson sleep laboratory has completely shifted towards utilization of the third-party vendor for HSATs. The vendor specializes in handling, shipping and disinfecting the HSAT equipment. They send the data electronically to the Jefferson sleep laboratory for interpretation.

We propose a single-use, fully disposable HSAT kit (WatchPAT One) to further minimize potential virus exposures and spread. The single-use design allows no return shipment, no charging or downloading, no cleaning and no infection transmission risk.

Since the equipment utilizes a different mechanism - peripheral arterial tone (PAT) signal …

Training New Providers Dobhoff Tube Insertion During Covid-19: Rapid Training And A Novel “Opt In” Approach To Learning, Michele Decastro, Msn, Crnp, Heather M. Etzl, Msn, Rn, Cbc, Jacqueline E. Crawford, Ms, Rn, Accns-P

Health Equity and Quality Improvement (HEQI) Summit

As increasing numbers of Covid-19 patients were admitted to the hospital and progressed thru their disease course, the Division of Hospital Medicine noted an increased need for enteral feeding access for their patients. At the same time, the Nutritional Support Clinical Nurse Specialists were seeing an increase in requests for assistance with use of Cortrak technology for insertion of Dobhoff tube (DHT) insertion for high risk patients diagnosed with Covid-19.

Progression Of Patient Cohorting In Response To Covid-19 At The Jefferson Methodist Emergency Department, Kory S. London, Md, Efrat Kean, Md

Health Equity and Quality Improvement (HEQI) Summit

While COVID-19 and it’s various complications are a source of a substantial number of Emergency Department (ED) visits, many patients still arrive to the ED for non-COVID-19 indications.

Due to pre-existing construction which was halted by the pandemic, external space for a tent configuration was unavailable.

In effort to decrease patient, staff and nurse exposure to COVID, a system of cohorting was created to assure uninterrupted service in a manner as safe as possible for all involved.

Given the uncertainty of patient volumes and the potential for a high burden of disease similar to our colleagues in New York and …

Progression Of Patient Cohorting In Response To Covid-19 At The Jefferson Methodist Emergency Department, Kory S. London, Md, Efrat Kean, Md

Health Equity and Quality Improvement (HEQI) Summit

COVID-19 is a predominantly respiratory disease and Philadelphia is a city with a myriad of pulmonary comorbidities such as asthma and COPD.

Use of bronchodilator medications through a nebulizer machine is considered an 'Aerosol Generating Procedure' (AGP), and increases risks to staff who and complicates the cleaning and processing of rooms and equipment where AGPs are performed. Additionally, there is a severe limitation in availability of negative pressure rooms, which mitigate these AGPs.

With the COVID pandemic causing supply chain problems across the country, a multidisciplinary approach was required to appropriately ration available inhalers (MDI), the alternatives to nebulized treatments, …

Screening Tool To Ensure Optimal Patient Care And Function Post Covid Diagnosis, Nethra Ankam, Md, Shannon Ames, Pt, Dpt, Mba, Tiffany Prince-Kandrakota, Pt, Dpt, Ocs, Erica Rao, Pt, Dpt, Namrata Grampurohit, Phd, Otr/L, Catherine Piersol, Phd, Otr/L

Health Equity and Quality Improvement (HEQI) Summit

We developed a screening tool of questions to determine which patients would benefit from outpatient PM&R visits after discharge from the hospital/ED that included: four questions looking at function, shortness of breath and cognition. Screening questions were created so a YES response triggers a referral to PM&R to assess functional and cognitive needs for the patient.

Ensure Follow-Up For Functional Issues Post Covid-19, Nethra Ankam, Md, Tulasi Gude, Md, Kristofer Feeko, Do, Shannon Ames, Pt, Catherine Piersol, Ot, Tiffany Prince-Kandrakota, Pt, Erica Rao, Pt, Kristen Stout, Pt, Monina Florendo, Pt

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

Patients post COVID-19 infection have functional limitations at home related to the multi-system effects of the infection, in addition to elevated risk for post-intensive care syndrome.

Our goals were to ensure patients had the resources they needed to safely mobilize at home, ensure referral to appropriate agencies for home care and therapies, and provide guidance on return to life activities in the setting of the stay-at-home order, need to self-quarantine, and limited outpatient therapy options.

Response To Rapidly Changing Healthcare Information Regarding Covid-19 With Virtual Journal Club, Kelly Hughes, Md, Rachel Redfield, Md, Jetmir Vojnika, Md, Mark Mallozzi, Md, R. Benson Jones, Md, Reem Aoun, Md, Dianna Cheney-Peters, Md

Health Equity and Quality Improvement (HEQI) Summit

Virtual twice weekly COVID-19 journal club (JC) created to optimize residency and faculty education regarding COVID-19 management, critical appraisal of new literature, and improve departmental collaboration and connection.

Safer Ambu-Bag Manual Ventilation Through Addition Of A Second High Efficiency Particulate Air (Hepa) Filter, Robert Ries, Morgan Hutchinson, Md, Robert Pugliese, Pharmd, Bon Ku, Md, Mpp, Matt Fields, Md

Health Equity and Quality Improvement (HEQI) Summit

• Experts from the Thomas Jefferson University Health Design Lab met with Emergency Medicine and Anesthesia physicians and local engineers
• A design was envisioned in which 3-D printed connectors could be created to add an additional HEPA Filter as shown in Figure 1
• STL Files for the adapters were created based on standard HEPA filter diameters and 3-D printed
• The second HEPA filter was easily assembled by novice users using the adapters
• Ventilation adequacy using the double HEPA filter ambu-bag was similar to single HEPA filtered ambu-bag ventilation based on observed inflation of a test lung