Medicine and Health Sciences Commons^™

Joint Annual Wellness Visit Scheduling, Rob Chamberlin, Jennifer Bliss, Andrea Lai, Paula Dougherty, Deb Swett, Logan Merrithew, Pam Stevens, Scott Williams

Maine Medical Center

Problem/Impact Statement: The pharmacists in Scarborough & Westbrook Primary Care conduct Medicare Annual Wellness Visits (AWVs) with a physician. The pharmacist and physician see the patient individually. The practices achieved and sustained FY18 Joint AWV volume goals through a new process to reschedule physician-only AWVs to Joints AWVs with a pharmacist. This leads to reschedule rework and reduced time practice staff have for patient care.

Improving Patient Experience And Education By Leveraging Technology, Cathy Palleschi, Wendy Osgood, Mark Parker, Cecilia Inman, Alicia Russell, Eileen Shanahan, Erin Pappal

Operational Transformation

It is estimated that 65% of the population are visual learners. With that in mind, a team of cardiac nurses in a large academic tertiary hospital developed a quality improvement project to hopefully improve patient engagement as well the patients’ perception that the nurses explained things in a manner that they could understand.

Baseline patient survey scores for the question, “Nurses Explained Things In A Way That I Understand”, were under the 75^thpercentile for a period of 9 months. A root cause analysis was conducted and it demonstrated numerous reasons for this score.

Several countermeasures were instituted to …

Development Of Mechanical Ventilator Educational Brochure For Patients/Families, Cathy Palleschi, Wendy Osgood, Mark Parker

Operational Transformation

Patients on mechanical ventilation often have no memory of events while being ventilated. In addition, families during this time, are often overwhelmed and unable to retain information provided to them by caregivers.

In attempt to address these issues, a team of care providers in an tertiary academic hospital established a goal to create a mechanical educational brochure with the goal to reduce associated anxiety and improve overall understanding of information provided.

As part of a clinical transformation project, a root cause analysis was conducted and a number of countermeasures were initiated. Some of these included a survey to capture feedback …

Treating Substance Use Disorders: Enhancing Attendance At The Weekly Inpatient Medication Assisted Treatment Group, Devon Gillis, Jayne Weisberg, Dena Whitesell, Amy Mcauliffe, Amy Sparks, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

Operational Transformation

At a large academic tertiary medical center, an Integrated Medication Assisted Treatment (IMAT) program has been established for those medically stable inpatients with an addiction diagnosis. Over a four month period, this program had experienced a decline in attendance and a quality improvement project was initiated is to better understand the barriers to attendance and institute a process that would reverse the decline.

A goal was established to improve attendance by medically stable patients that have consented to participate to a minimum of 50%.

A root cause analysis outlined numerous causes for low attendance and several countermeasures were established to …

A Coaching And Team Performance Evaluation Model To Build Capacity For High-Impact Lean Improvement, Ruth Hanselman, Mark Parker, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operational Transformation

There is abundant evidence that links a strong culture of safety with improved patient and staff experience. However, there has been no clear avenue identified as to how to achieve this metric.

A team in a large academic tertiary teaching hospital set about leveraging their daily managing system (DMS) to attain improvement in their institution’s safety. The goals of this quality improvement project were to use DMS to identify and report safety concerns and increase frontline team knowledge and comfort with reporting safety concerns during Gemba walks.

A root cause analysis identified 5 areas for improvement and several countermeasures were …

Facilitating Earlier Discharges To Decrease Avoidable Patient Days And Improve Flow For An Acute And Intermediate Care Unit, Natasha Bartlett

Operational Transformation

No abstract provided.

Strengthening Safety Culture By Leveraging The Daily Management System, Suneela Nayak, Mark Parker, Erin Graydon Baker, Amy Sparks, Ruth Hanselman, Stephen Tyzik, Sydney Green

Operational Transformation

STRENGTHENING SAFETY CULTURE BY LEVERAGING THE DAILY MANAGEMENT SYSTEM

There is abundant evidence that links a strong culture of safety with improved patient and staff experience. However, there has been no clear avenue identified as to how to achieve this metric.

A team in a large academic tertiary teaching hospital set about leveraging their daily managing system (DMS) to attain improvement in their institution’s safety. The goals of this quality improvement project were to use DMS to identify and report safety concerns and increase frontline team knowledge and comfort with reporting safety concerns during Gemba walks.

A root cause analysis …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …

Reduction Of Catheter Associated Urinary Tract Infections (Cauti) In A Critical Care Setting, Deborah Jackson, Lindsey Lucas, Shawn Taylor, Jonathan Archibald, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

Urinary tract infections (UTIs) are the most common type of healthcare associated infections. Seventy five percent are related to indwelling urinary catheters. These infections come with increased morbidity and mortality risk. A team of intensive care providers at a large academic tertiary medical center initiated a quality improvement project to reduce the number of CAUTIs.

Baseline data established the total number of catheter days and CAUTIs by month. A subsequent root cause analysis was completed and several counter measures were developed to include a KPI implementation to track that all intensive care providers are educated in CAUTI and creation of …

Improving Patient Flow By Increasing Early Discharges On A Mother & Baby Unit, Faye Weir, Joy Moody, Kathleen Cyr, Cathy Palleschi, Stephen Tyzik, Joseph East, Heidi Morin, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

Discharging patients early in the day has many advantages amongst which is increased bed availability. However, the experience in a large academic tertiary medical center demonstrated that most discharges occurred early to mid afternoon. A care team on a mother /baby unit established a quality improvement project to increase the number of discharges by 11AM and streamline key discharge planning activities.

A root cause analysis identified multiple barriers to attaining he established goals. To address these barriers, a multi prong approach was instituted to include a discharge education KPI for all unit staff.

Data collection post countermeasure implementation demonstrated some …

Improving The Workflow And Partnership Between Registration And Clinical Staff In An Outpatient Urgent Care Center, Melissa Fairfield, Bailey Eells, Faye Collins, Joyce Cornish, Stephen Tyzik, Joy Moody, Wendy Osgood, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

An outpatient urgent care unit was experiencing challenges in balancing the need to register patients and delivering care in the timeliest manner as possible. Upon examination, it was found that delays were being experienced in patient triage and discharge that resulted in low patient satisfaction scores.

A team of providers was established to review all process steps and a quality improvement project was created to attain a goal of 100% of the time discharge would not be delayed due to incomplete registration.

Baseline metrics demonstrated current numbers of delayed discharges, median time from door to triage as well as door …

Using Shared Decision Making And Team-Based Care To Overcome Socioeconomic And Cultural Barriers To Colorectal Cancer Screenings, Amanda Powell, Debra L. Pyle, Kristin Rowse, Misty Weeman, Rachel Kidder, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operational Transformation

Colorectal cancer is the third leading cause of cancer death in the United States. It disproportionally affects minorities and those in lower socioeconomic groups. The use of fecal immunochemical testing (FIT) is a low barrier, low cost and low risk screening tool as compared to the traditional colonoscopy exam. The use of FIT offers the opportunity to overcome barriers such as cultural, economic and low health literacy.

As part of a large health care system, an internal medicine clinic wanted to increase the use and return of FIT in their clinic patients. A team developed a plan for implementing improvement …

Increase Staff Utilization Of Occlusive Interface In Micro-Preemie Babies On Bcpap, Deborah A. Igo, Kimberly Kingsley, Faythe Henry, Misty Melendi, Amy Mcbee, Valerie Cook, Christopher Woods, Angela Rojecki, Lauren Walley, Amy Sparks, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Operational Transformation

Premature neonates born before 26 weeks gestation present many care challenges as they need special precautions to be taken to overcome their fragility. Intubation is often needed for this patient population as their lungs are not fully developed. However, due to their high susceptibility for skin breakdown invasive ventilation often can create subsequent problems. A respiratory therapist team in an academic tertiary medical center wanted to explore the use of an occlusive interface for intubation while providing various forms of non-invasive ventilation in their NICU with the hopes for fewer complications.

The objective of this project was to reduce the …

Increasing Advanced Care Planning In An Ambulatory Care Setting, Jennifer Aronson, Elizabeth Eisenhardt, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operational Transformation

Maine is experiencing an increasing percentage of its population being over 65 years old. Advanced Care Planning (ACP) is an important part of this aging population medical care so those ends of life preferences are known well in advance. An adult internal medicine clinic in a large academic tertiary medical center decided to create a performance improvement project that addressed ACP with embedded workflows.

The goal of this project was to have a minimum of 40% of patients 65 or older have an Advanced Care Directive or Serious Illness Conversation documented in EPIC.

Baseline metrics demonstrated that ACP discussion rates …

Nicotine Replacement Therapies To Decrease Withdrawal Symptoms And Improve Patient Experience, Cheryl Pawloski, Holly Stewart, Devon Gillis, Dena Whitesell, Maya Bulman, Christopher Racine, Raymond Serrano, Leslie Gatcombe-Hynes, Elizabeth Mullany, Amy Mcauliffe, Jayne Weisberg, Amy Sparks, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

Operational Transformation

Smoking is one the leading causes of preventable death in the United States. Patient centered care revolves around encouraging patients to reduce their chances of preventable disease and death. To that end, nicotine replacement therapy (NRT) prescribed within 24 hours of hospital admission increases the chance of quitting and decreases the chance of nicotine withdrawal.

A pilot performance improvement project was initiated on two cardiac units at an academic tertiary medical center. The goal the project was to have NRT ordered within 24 hours of admission 100% of the time. Baseline metrics demonstrated admission NRT orders were below acceptable levels …

Intensive Care To Intermediate Care Bridge Program, Natasha Bartlett, Sally Langerak, Lindsey Lucas, Jonathan Archibald, Tayla Robbins, Miranda Thompson, Patrice Tetu, Calla Hastings, Megan Garland, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operational Transformation

To deliver the highest quality of care across the continuum, a large academic tertiary medical center envisioned a project that would provide an internal source of cross trained nurses for their medical intensive care unit (SCU2) and their medical intermediate care unit (R4/IMC/AVU). The hope for this program was to improve communication and collaboration between nurses and enhance the care that they provide to patients and their families.

A highly qualified team of nurses was established to create a performance improvement project. The overall goal of this endeavor was to build a more collaborative relationship between the units and ultimately …

Increasing Access To Spiritual Care Services In The Emergency Department: A Patient And Staff Support Model, Heather Weidemann, Tia Jamir, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operational Transformation

In trauma centers, there is evidence that interfaith spiritual care reduces emotional distress and improves health outcomes. In order to be effective in providing timely support, chaplains must be integrated into the clinical care team.

In an academic tertiary medical care center, a spiritual care team felt there were numerous missed opportunities to offer support to ED patients and its staff due to lack of being part of the care team. As a result, a performance improvement project was developed with the overall goal of integrating spiritual care into the ED clinical setting.

Baseline metrics and a root cause analysis …

Increasing First Case On Time Starts In An Ambulatory Surgery Center, Diane Fecteau, Shannan Reid, Sydney Green, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operational Transformation

In an ambulatory surgical center, first case on-time starts directly affects the patient experience. In addition, in order to treat as many patients as possible, delays of first case on-time starts negatively impacts the rest of scheduled surgical patients and increases staff overtime expenditures. An ambulatory surgical team within a large urban health care system initiated a performance improvement initiative to enhance the patient experience, increase staff accountability and care team well-being.

The goal of this project was to start 70% or more first cases on time. Baseline metrics demonstrated that patients and surgeons were the largest cause of delay. …

Retrospective Evaluation Of Weight Loss In Maine Medical Center Cancer Institute (Mmcci) Patients Receiving Radiation Treatment For Head And Neck Cancer, Julian Johnson, David Debartolo-Stone, Jessica Moore, Ruth Hanselman, Stephen Tyzik, Suneela Nayak, Amy Sparks

Operational Transformation

Treatment for head and neck cancer often results in weight loss as a side effect. One option to mitigate this weight loss is placement of a percutaneous endoscopic gastrostomy (PEG) tube placement. Radiation oncologists at a academic tertiary medical center discuss the option of PEG placement during patient consultation.

A retrospective evaluation of weight loss in patients receiving radiation was conducted over a two-year period. The goal of this data collection was to create a standard for oncology consultations regarding PEG tube placement.

Baseline metrics and a root cause analysis drove subsequent data collection steps. After analyzing the raw data, …

A Provider-Driven Approach To Preventative Oral Care In Nursing Home Facilities, Molly Anderson, Brandon Mccrossin, Kary Franchetti, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operational Transformation

Oral care is an essential part of preventative medicine as it minimizes risk for pneumonias and other infections. In nursing home settings, often oral health care is not routinely provided due to a number of issues. A health care system that either owns or contracts nursing home facilities initiated a performance improvement plan to address this patient care concern.

The first goal of this project was to reduce the variation in oral care between nursing home facilities within the system. The second goal was 100% of their patients will have one oral health care exam documented in EPIC once a …

Safe Care For Seizure Patients On An Epilepsy Monitoring Unit, Deborah Bachand, Lauri Wilson, Rachel Caiola, Lynne Keller, Megan Selvitelli, Mary Jo Farley, Jennifer O'Neill, Sara Shrock, Hannah Plummer, Sally Prokey, Amy Sparks, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Operational Transformation

Seizure patients admitted to an Epilepsy Monitoring Unit located within an academic tertiary medical center have a high potential to impact patient safety. As a result, a unit based team identified a need for a higher level of training for both their staff and float companions to ensure safe and standardized care for this group of patients.

The goal of this quality improvement project was to create an educational tool that would assist 100% of staff in better recognizing and responding to seizures. Baseline metrics and root cause analysis demonstrated a lack of consistent information being taught, a poorly identified …

Enhancing Interprofessional Collaboration And Communication With Art, Amy Moore, Dina Mckelvy

Maine Medical Center

An overview of the Art & Medicine, an interprofessional program piloted by Maine Medical Center Library and Knowledge Services in the fall of 2018.The poster details learning objectives, themes and activities offered during this four session, evening event.

Prions To Pathways: Safeguarding Against Creutzfeldt-Jakob Disease In The Operating Room, Jessica Mary Adams Atkinson, Sonja Carol Orff

Maine Medical Center

Introduction:

As defined by the Center for Disease Control (CDC, 2018), Creutzfeldt-Jakob Disease (CJD) is a rapidly progressive, rare, transmissible, and fatal illness. Miscoiling of healthy proteins caused by an abnormal isoform of cellular glycoprotein resulting in protein folding has been found to be the molecular mechanism during the pathological process of this malady (Figure 1), (Castle, Gill, 2017). The current problem is that few recommendations are available for organizations to consider how to manage potential CJD patient cases, and institutions are left to compile and develop their own guidelines and/or protocols for clinical practice. The standards of care for …

Increasing Doses Of Intraoperative Hydromorphone Do Not Reduce Postoperative Pain, Craig S. Curry, Michael B. Henry, Wendy Craig, Janelle M. Richard, Denham S. Ward

Maine Medical Center

Introduction:

• Intermediate and long acting opioids are given intraoperatively to reduce pain during emergence from anesthesia.

• Recent evidence suggests that intraoperative opioids have inconsistent effects on nociception and pain in the immediate postoperative period.

• Multiple potent, short-acting opioids such as remifentanil, sufentanil and fentanyl have been shown to produce dose-related increases in pain scores and opioid consumption in the immediate postoperative recovery period.

• Intraoperative doses of longer acting opioids such as morphine and methadone6 have been shown to reduce pain scores and narcotic requirements in the immediate postoperative period.

• Hydromorphone is an intermediate duration narcotic …

Impact Of Palliative Care Consultations For Patients Admitted To Maine Medical Center With Acute Exacerbations Of Copd, Benjamin Jarrett, Isabella Strumpf, Rebecca Hutchinson

Maine Medical Center

Background and purpose:

• COPD is the 3rd leading cause of death.

• Specialty Palliative Care (PC) is underutilized in COPD patients.

•PC involvement has been shown to improve quality of life and satisfaction with overall care.

• We sought to evaluate the association of receipt of palliative medicine consultation during an admission for acute exacerbation of COPD with a documented Goals of Care conversations and/or presence of an advanced directive and/or POLST.

Outpatient Treatment Of Pulmonary Embolism: A Single-Center Case Series, Annie Huyler, Casey Z. Macvane, Andrew Perron, Tania D Strout

Maine Medical Center

Background: Pulmonary embolus (PE) is associated with significant utilization of health care resources and financial burden Several additions that have allowed us to look at safely treating patients with PEs as outpatients:

• Simplified Pulmonary Embolism Severity Index (sPESI) -Risk stratifies patients based on their age, vital signs, and past medical history

• Novel oral anticoagulants

Primary Objective: To describe the population, treatment strategies, short-term complications and outcomes associated with outpatient management of PE following treatment in the ED.

Outcomes Of Implementation Of An Evidence-Based Enteral Feeding Protocol In Neonates Weighing Less Than 1800g At Birth, Rebecca Edwards

Maine Medical Center

Background:

Several studies have demonstrated that the implementation of standardized enteral feeding guidelines can lead to positive outcomes in the neonatal intensive care unit (NICU), including improved nutrition, decreased need for parenteral nutrition (PN), central lines and decreased costs. Furthermore, implementation of standard feeding regimens have significantly reduced the incidence of necrotizing enterocolitis (NEC), a devastating gastrointestinal emergency in neonates. It has been reported that NEC has an iatrogenic component related to variations in feeding practices. While the exact mechanism of the reduced risk of NEC and implementation of feeding protocols is unclear, standard feeding regimens likely improve consistency in …

Physician-Patient Communication About Genomic Tumor Testing: Perceptions Of Oncology Providers, Hayley Mandeville, Eric Anderson, Kimberly Murray, Caitlin Gutheil, Leo Waterston, Lee Lucas, Christine Duarte, Christian Thomas, Susan Miesfeldt, Petra Helbig, Andrey Antov, Jens Rueter, Paul Han

Maine Medical Center

Background:

• Genomic tumor testing (GTT) is a new technology and a cornerstone of the “precision medicine” movement in cancer care.

• GTT uses next-generation genome sequencing technology to identify somatic variants in tumor cells.

• By identifying somatic variants that predict responses to cancer therapies, GTT can help tailor therapy to individual patients, making them more effective.

• However, due to the fact that GTT also detects many variants of uncertain significance, its clinical value is currently unproven.

• When using GTT, physicians counsel patients about both its benefits and its limitations, but the ideal goals and content of …

Delayed Initiation Of Therapeutic Hypothermia For Outborn Infants Is Associated With Adverse Outcomes, Nabeel Hashmi, Max Sale, Leah Fox, Jay Kerecman, Lauren Mcallister, Misty Melendi, Frances Lucas

Maine Medical Center

Delayed Initiantion of Therapeutic Hypothermia for Outborn Infants is Associated with Adverse Outcomes

Predictors For Discharge After Robotic Hysterectomy – A Retrospective Analysis, Heidi Fox, Kristiina Hyrkas

Maine Medical Center

Introduction:

Hysterectomy is one of the most common surgeries performed in the United States with more than 600,000 procedures annually . It has been estimated that in 2011, there were more than 64,000 surgeries performed in an outpatient setting. The highest rate of 0.46% (464/100,000 adult women) has been reported in Maine. The average length of stay was 0.65 days for laparoscopic and 0.79 days for vaginal hysterectomies [1]. Traditionally, hysterectomies have been performed as an inpatient procedure to manage postoperative pain and monitor complications such as bleeding, anemia and return of bowel function. Development of minimally invasive surgery techniques …