Medicine and Health Sciences Commons^™

The Implementation And Efficacy Of A Breast Cancer Wellness Group At Thomas Jefferson University Hospital, Steven Woodward, Md, Peter Altshuler, Md, Theodore N. Tsangaris, Md

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

Abstract

Introduction: Breast cancer is not only a physical disease but something that affects our patients’ mental, spiritual, emotional and social wellbeing. There has been literature that demonstrates the positive benefits of exercise, social support, and nonmedical adjuncts for breast cancer patients. There is currently a lack of wellness support within the Jefferson breast cancer community.

Methods: A wellness survey will be distributed throughout the breast surgery and breast oncology clinics to assess the current level of wellness and interest in a breast cancer wellness group at TJUH. This survey will be used both before and after implementation …

Lack Of Utility And Excess Cost Of Routine Perioperative Hematologic Testing In Patients Undergoing Elective Neurosurgical Procedures Of The Spine, Lucas Philipp, Md, Mph, Catriona Harrop, Md, David Wyler, Md, James Harrop, Md

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

Objective

To prospectively conduct a "mock trial" among 100% (minimum n=200) of elective neurosurgery spine patients to estimate the total projected cost, savings, risk, and feasibility of a redefined/restricted lab testing protocol over the next 12 months

Stopping Clots While Saving Time: Creating An Epic Index For A Vital Daily Task, Juergen Kloo, Md, Jeffrey Riggio, Md

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

Introduction

• Appropriate thromboprophylaxis is a pressing issue across the united states and the rate of VTE at Thomas Jefferson University Hospital is higher than hospitals of similar complexity.
• A new tool was created for our EPIC EMR, the VTE Merli Index, that provided at a glance and detailed feedback regarding VTE prophylaxis status
• Prior to implementation of the index, we studied its ease of use. Our goal was to show the tool would decrease the amount of time and number of clicks required to interrogate the EMR for relevant VTE information by at least 50%.

Every Minute Counts: Using Health Information Technology To Reduce Chart Abstraction Times, Christine Schleider, Rn, Bsn, Cnor, Adam P. Johnson, Md, Mph, Kathleen Shindle, Rn, Bsn, Ccds, Henry A. Pitt, Md, John R. Kairys, Md, Scott W. Cowan, Md

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

No abstract provided.

Application Of Alvimopan As A Component Of Enhanced Recovery After Surgery (Eras) Protocol For Patients Undergoing Radical Cystectomy And Diversion (C&D), Thomas Hardacker, Md, Mba, May Jean Counsilman, Md, Benjamin H. Rudnick, Md, Edouard J. Trabulsi, Md, James R. Mark, Md, Leonard G. Gomella, Md, Mark J. Mann, Md, Costas D. Lallas, Md, Scott G. Hubosky, Md

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

Introduction

• Radical cystectomy with urinary diversion (C&D) is performed for patients with muscle-invasive bladder cancer (MIBC) or refractory carcinoma in situ (CIS)
• C&D patients receive one of several types of diversion depending on their age, comorbidities, functional status, and extent of disease (Figure 1)
• Post-operative length of stay (LOS) can be prolonged (9-11 days) and 30 day readmission rates and mortality elevated (30% and 1.5%); return of bowel function usually the rate-limiting step to discharge
• Enhanced Recovery After Surgery (ERAS) protocols utilize pre-, intra-, and postoperative elements in order to improve return of bowel function and decrease LOS
• Alvimopan is …

Coaching Operating Room To Pacu Handoff With A Standardized, Multidisciplinary Checklist, Courtney L. Devin, Md, Kathleen Grife, Rn, Ms, Marissa Weber, Md, Richard F. Schmidt, Md, Megan P. Lundgren, Md, Scott W. Cowan, Md

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

Purpose

To pilot a standardized multidisciplinary bedside handoff for any patient admitted to the post-anesthesia care unit (PACU) from the operating room.

Getting Rid Of Stupid Stuff (Gross) Committee: Residents Dedicated To Streamlining Epic-Related Workflow, Nkosi H. Alvarez, Md, Christina L. Jacovides, Md, Brian M. Till, Md, Walker Lyons, Md, Keyur Patel, Md, Richard Zheng, Md, Adam Johnson, Md, John Kairys, Md

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

Objectives

• Identify specific mechanisms for submitting and implementing improvements to the Epic environment
• Standardize high-use order sets
• Incorporate high-value modular components into existing order sets
• Create new order sets to streamline resident workflows
• Improve communication between stakeholders

Creation Of An Institutional Toolkit For Evaluation Of Multidisciplinary Handoffs, Richard F. Schmidt, Md, Courtney Devin, Md, Nicholas Tarangelo, Md, Andrew Mendelson, Md, Bracken Babula, Md, Rebecca Jaffe, Md

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

Objectives

1. Create a method for analyzing different handoffs in a variety of clinical settings and scenarios at TJUH.
2. Develop a set of standardized survey tools using existing validated language to quantify the perceptions, quality, and needs for different patient care transitions.
3. Use results from these tools to cater focused handoff improvement interventions for specific patient care settings.

Improving Postoperative Handoffs In The Neuro-Intensive Care Unit, Richard F. Schmidt, Md, Andrew Mendelson, Md, Sonia Gill, Md, Nicole Hollup, Crnp, Matthew Vibbert, Md, Coleen Vernick, Md, Giuliana Labella, Msn, Marie Wilson, Msn, Caitlin Harley, Msn, Maryanne Mccarrin, Msn, Jack Jallo, Md, Rebecca Jaffe, Md

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

Introduction

• Transitions of care represent a major source of medical errors, patient morbidity/mortality, and increased healthcare waste.
• 2018 CLER report indicated largely unfavorable responses toward handoffs and care transitions for perioperative services and neurointensive care.
• Use of the IPASS handoff tool is associated with up to 30% reduction in adverse events and 23% reduction in medical errors.
• Implementation of IPASS for postoperative handoffs in the SICU resulted in improved organization, safety, and communication.

Implementation Of Standardized Discharge Instructions, Caitlin Hodge, Md, Quyngdiem Lam, Md, Luis A. Mejia, Md, Orlando C. Kirton, Md, Facs, Mccm, Fccp, Mba, Robert Josloff, Md, Kristin Noonan, Md

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

Introduction

Previously, same-day surgical discharge instructions were handwritten by residents on generic fill-in-the-blank forms leading to inconsistent discharge instructions. Residents started an initiative to create these standardized discharge instructions. These instructions were designed to improve documentation for post-operative instructions as well as enhance overall patient safety in an attempt to eliminate miscommunications with patients.

“Can You Send Over The Imaging?” Analyzing The Patient Transfer Process At Tjuh, Walker Lyons, Md, Peter Altshuler, Md, Andrew Hallett, Md, Lindsay Lynch, Md, Tommy O'Malley, Md, Steven Woodward, Md, Alicja Zalewski, Md, Scott Cowan, Md

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

Objective

Our goal was to investigate possible ways to improve the transition of care when patients are transferred to Jefferson Center City. As a quaternary care hospital with a large transfer volume, it is especially important to look for ways to optimize this process because it can improve timely patient care, reduce and eliminate unnecessary studies and diagnostic tests and save time and work that could be better spent in other aspects of treating the patient.

Developing A Neurosurgical Spine Post-Operative Note Template On Epic For Improved Multi-Disciplinary Care, Omaditya Khanna, Md, Geoffrey P. Stricsek, Md, Giuliana Labella, Rn, James Harrop, Md, Jesse Edwards, Md

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

Introduction

The care of neurosurgical spine patients often involves a multi-disciplinary team, including neurosurgery residents, hospitalists, nursing staff, and physical/occupational therapists.

Oftentimes, post-op spine patients are on a non-neurosurgical service (hospitalist, MICU/SICU, medicine), who are provided with scant sign out on the procedure(s) performed.

The treatment team(s) that are helping manage patient care post-operatively are often unaware of the procedure performed, and what are the salient clinical signs/symptoms, radiographic findings, and laboratory values that need to be closely monitored

Implementation Of Attending-Supervised Ipass Handoff In The Neuro-Icu, Laura Cifrese, Md, Sonia Gill, Md, Megan Margiotta, Md, Muhammad Athar, Md, Rodney Bell, Md, Sara Hefton, Md, Fred Rincon, Md, Msc, Mbe, Syed Shah, Md, Mba, Jacqueline Urtecho, Md, Matthew Vibbert, Md, David Wyler, Md, Amandeep Dolla, Md

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

Background

• Duty hour restrictions, cross coverage, and the growing number of mid-level practitioners has led to an increased number of handoffs across medical specialties
• These handoffs are well-known points of communication breakdown which can lead to patient safety issues
• Factors contributing to an effective handoff include standardization of communication, appropriate training and supervision, ample time, a quiet environment, and a supportive culture
• We hypothesize that attending supervision of handoffs is feasible and can improve practitioner perception of transitions of care

Establishing Cost-Effective Management Of Postoperative Urinary Retention After Spine Surgery, Nikolaos Mouchtouris, Md, Catriona Harrop, Md, Edward Kloniecke, Md, Victoria English, Crnp, David Wyler, Md, Kamini Patel, Rn, Mba, Ashwini Sharan, Md, James Harrop, Md

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

Goal

Our goal is to develop evidence-based guidelines that:

1. streamline the order/timing of interventions in patients who develop PUR after spine surgery
2. identify those at high-risk of long-term urinary retention that require further workup
3. minimize the rate of PUR –goal is to reduce to 3.5% in FY 2019
4. and determine the cost savings from our intervention when applied to all surgeries

Improving Medical And Endovascular Management For Acute Ischemic Stroke Through Multidisciplinary Education And Simulation, Richard F. Schmidt, Md, Megan Margiotta, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Robin Dharia, Md, Maria Aini, Md, Diana Tzeng, Md, Fred Rincon, Md, Pascal Jabbour, Md, Nabeel Herial, Md

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

Primary goals:

1. Reduce door to treatment times (both DTN and DTP) to meet and exceed existing guidelines metrics.
2. Educate residents about acute stroke management, including national guidelines and new institutional protocols to improve efficiency during stroke alerts.

Standardized Discharge Instructions And Their Impact On Post Operative Patient Knowledge, Nikolaus Hjelm, Md, Gregory Epps, Md, Ryan Rimmer, Md, Lauren Bogdan, Md, Erin Reilly, Md

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

After every surgery, surgeons send their patients home with discharge instructions. The information is intended to educate the patients about their postoperative care and how to safely care for themselves upon returning home. Each surgeon reviews and approves the discharge instructions before they are given to their patients. This information is once again reviewed by the patient’s nurse before the patient leaves the hospital.

Within a large hospital, there are often several surgeons within each specialty that perform the same surgeries. The department of Otolaryngology at Thomas Jefferson University Hospital is no exception. Within otolaryngology there are several subspecialties. At …

Optimizing Physical Therapy Sessions Among Patients Undergoing Elective Lumbar Surgery, Ellina Hattar, Md, Kelly Hufford, Dpt, Marie Wilson, Rn, James Harrop

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

Background

Physical therapy is imperative in achieving early mobilization, thereby reducing morbidity of immobility such as venous thrombolic events, improving postoperative pain, and facilitating appropriate disposition among patients who have recently undergone spine surgery. At TJUH, patients undergoing elective spine surgery are planned to engage in physical therapy (PT) twice a day. There are however several impediments that may limit the ability of patients to adequately participate in PT.

Process Improvement For Endovascular Thrombectomy In Patients Presenting With Acute Ischemic Stroke, Richard F. Schmidt, Md, Michael J. Lang, Md, Robin Dharia, Md, Fred Rincon, Md, Thomas Zdanowski, Rn, Msn, Robin D'Ambrosio, Rn, Msn, Stavropoula Tjoumakaris, Md, M. Reid Gooch, Md, Pascal Jabbour, Md, Nabeel Herial, Md

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

Aims

1. Critically evaluate the existing stroke activation and ET protocols for compliance with new 2018 metrics and guidelines.
2. Review DTP times under the existing protocol to assess for potential inefficiencies or gaps in care delivery, specifically addressing differences between processes at JHN compared to ED/Gibbon.
3. Make changes to the existing stroke alert protocol to better reflect current guidelines, streamline care, and ultimately improve process metrics (DTP times).
4. Establish a system for recursive continuous analysis of AIS patients to identify protocol gaps, inefficiencies and areas for further intervention.

Screening For Venous Thromboembolism In Asymptomatic Trauma Patients: Effective In High Risk Patients, Seth Stake, Bs, Adam Wallace, Bs, Deepika Koganti, Md, Pgy-4, Adam P. Johnson, Md, Mph, Joshua A. Marks, Md, Scott W. Cowan, Md, Murray Cohen, Md

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

Hypothesis:

Through data analysis of a large cohort of trauma patients, a clinically applicable protocol can be developed based on various predisposing factors for VTE in asymptomatic patients. By isolating the factors that make these patients high risk for VTE, we can effectively lower the incidence of PE in hospitalized trauma patients.

Medical Student And Resident Foley Catheterization Training Program To Decrease Post-Operative Catheter Associated Urinary Tract Infections, Peter J. Altshuler, Adam P. Johnson, Md, Mph, Danica Giugliano, Md, Gerald A. Isenberg, Md, Scott W. Cowan, Md

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

Objective:

Determine whether a more comprehensive medical student urinary catherer training curriculum can be successful in decreasing post-operative CAUTI rates in general and vascular surgery patient populations.

Primary target:

Reduce post-operative UTI rates by 0.5% over 6 months

Secondary targets:

Achieve 100% medical student confidence in Foley catheter placement, understanding indications and contraindications to urinary catheterization.

Improve objective performance of urinary catheterization skills as determined by objective clinical skills exam (OSCE) scores.