Medicine and Health Sciences Commons^™

Improving Emergency Department Efficiency Through Easier Access To Policies, Meryl Abrams, Md, Uma Damle, Md, Adam Brown, Do, Carlos Rodriguez, Md, Frederick Randolph, Md

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

Objectives

1. We aim to help residents, faculty and auxiliary staff to more easily locate and use institutional clinical policies.
2. To improve patient safety by having the institutionally developed policies be more readily available.

Reduction Of The Duration Of Contact Precautions In Patients With A Positive Mrsa Swab, Fadi Al-Saiegh, Md, Phyllis Flomenberg, Md, Giuliana Labella, Rn, Kelli Mcrory, James Harrop, Md

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

Background

Contact precautions (CP) in hospitals are a method of infection control in the transmission of multi-drug resistant organisms. Unfortunately, even though colonization with nasal methicillin-resistant Staphylococcus aureus (MRSA) is common in asymptomatic patients (3.8-4.5%) (6,7), patients are screened for nasal MRSA since it associated with higher morbidity and mortality. However, those who test positive for nasal MRSA are kept on CP even with a cleared MRSA infection(1). At TJUH, patients were kept on CP for 24 months after a positive swab regardless of location. This, unfortunately, led to unintended negative consequences: delay in patient transfer to other facilities (e. …

Scanning For Qi: Resident And Sonographer Driven Improvement Of Radiology Resident Ultrasound Technique, Brian Blumhof, Md, Corinne Wessner, Bs, Rdms, Rvt, Kristen Mcclure, Md

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

Objective

The aim of this structural QI project is to improve the educational ultrasound curriculum , thus improving overall resident confidence and technical ability in acquiring diagnostic quality sonographic images.

Comparing resident confidence levels and performance against their initial benchmarks as well as against yearly cohorts, we plan to create a long standing addition to the radiology residency at Jefferson, with plans to include additional ultrasound examinations as the curriculum becomes more robust.

Stakeholders include not only the radiology residency, which would benefit from improved resident education and knowledge, but also the hospital and ultimately patients, who stand to benefit …

Quality Time: Eeg Conference, Nicole Brescia, Md

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

Background

• Didactic conferences are a defining, common feature of the majority of training programs
• Comprise several hours a week
• Learners and educators from all different levels and backgrounds come together to share experience and knowledge
• Fosters an environment of trust and comradery.
• EEG conferences specifically provide the opportunity to see the perspectives on a study which is sometimes subjective with poor interrater reliability
• Our EEG conference is a recent addition, along with the pediatric epilepsy fellowship, to the AI DuPont Neurology Department

Aspiration Pneumonia After Spine Surgery At Tjuh, Daniel Franco, Md, Jesse Edwards, Md, Kristen Vogl, Pt, Barbara Baskin, Slp, James Harrop, Md

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

Problem Definition

Aspiration Pneumonia after Spine Surgery at TJUH has a disproportionately high incidence, compared to other major academic centers When Aspiration Pneumonia is diagnosed in the immediate post operative period, this cascades into increased length of stay, increased overall cost and possibility negative impact for physician and hospital reimbursement At this time, it is unclear which criteria are used by physicians to determine whether an aspiration event has happened.

Improving Preventive Care In Patients With Improving Preventive Care In Patients With Inflammatory Bowel Disease Through Use Of A Standardized Checklist Tool, Andrew Elden, Richard Denicola, Amy Javia, Raja Dhanekula, Raina Shivashankar, Patricia Kozuch, Stephanie Moleski, Jorge Prieto

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

Study Aims

• Improve communication to referring PCP of the preventive care screening needs for IBD patients seen in the ambulatory setting.
• Implement system wide change through the use of a progressively modified EPIC based smart tool integrated directly into our provider notes.
• Increase adherence to guidelines for immunization, cancer screening, infectious screening, osteoporosis screening (DEXA scans), and smoking cessation counseling.

Neuroimaging Protocol In Patients Presenting With Spontaneous Intracerebral Hemorrhage, Kevin Hines, Md, Nikolaos Mouchtouris, Md, Karim Hafazalla, Jacob M. Mazza, Phillip Phan, Giuliana Labella, Muhammad Athar, Md, Adam Flanders, Md, Pascal Jabbour, Md

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

Introduction

While lacking evidence based recommendations, most institutions must evaluate spontaneous intracerebral hemorrhages (sICH) for hematoma expansion (HE). If unrecognized, it can be a devastating complication. However, because of the lack of general recommendations for serial imaging, many hospitals, including Thomas Jefferson, have arbitrarily instituted 6 hour an 24 hour stability head CT’s to evaluate for HE.

In our project, we examine the impact of this imaging protocol on the safety and quality of patient care and provide revised recommendations for imaging in sICH at Thomas Jefferson University Hospital and Jefferson Hospital for Neuroscience.

Improving Screening For Diabetic Retinopathy In An Ambulatory Resident Clinic, R. Benson Jones, Guy Katz, Jon Zaid, Navdeep Sangha, Rebecca Davis

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

Introduction

While 60% of Americans with diabetes are screened for diabetic retinopathy, the residents in the Jefferson Internal Medicine Associates (JIMA) ambulatory clinic had a lower screening rate (roughly 50%).(1) Our project aimed to increase that screening rate.

Improving Glycemic Control And Patient Follow Up In An Uncontrolled Diabetic Population At Jefferson Hospital Ambulatory Practice, Jennifer Hong, Md, Kamal Amer, Md, Sean Clark-Garvey, Md, Rachel Redfield, Md, Timothy Colangelo, Md, Roshni S. Patel, Pharmd, Albert Lee, Md

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

Aim

• Increase percentage of scheduled follow up appointments in our diabetic population by 50% within 8 months.
• Decrease percentage of uncontrolled diabetics by 10% within 8 months.

Rapid Response Checklists - A Pilot Study For A Novel Approach, Ali Rafiq, Md, Purujit Thacker, Md, Doron Schneider, Md

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

Objective

Our goal was to assess residents' ability to think of adequate differential diagnoses in a high-pressure scenario, and their perception of the utility of a checklist during rapid responses.

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

Moisture Chamber For Eye Care After Facial Nerve Injury, Ryan Rimmer, Md, Lauren Bogdan, Md, Gregory Epps, Md, Nikolaus Hjelm, Md, Erin Reilly, Md

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

Introduction

• Patients with various lesions of the head and neck may have compromise of facial nerve function.
• Facial nerve (CN VII) has various roles, including movement of facial muscles and, importantly, eye closure.
• When facial nerve is sacrificed or damaged during a surgical cases, steps are often taken intraop to surgically correct the deficit and allow eye closure. However, these patients may not immediately realize the benefit of these interventions.
• In the postop period, appropriate eye care is critical to prevent exposure keratopathy due to inability to close eye.
• Exposure keratopathy is damage to the cornea that occurs primarily due …

A Strategy For Noise Reduction To Improve Patient Experiences With Sleep (Snores), Vikas Sunder, Eitan Frankel, Neelam Upadhyaya, Merlin Mathew, Ritu Nahar, Michael Brister, Nicholas Young, Yair Lev, Md

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

Aim

Our aim was to improve patient-reported sleep satisfaction on the 5 W telemetry unit at Thomas Jefferson University Hospital over a 4 month time period (11/2018 to 2/2019) using a Marpac white noise machine.

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 …

A Qi Initiative To Reduce Time To Antibiotics In Oncologic Neutropenic Fever, Adam Binder, Jordan Villars

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

Problem Statement

Neutropenic fever (NF) (defined as temperature of 101o F on one occasion, or 100.4o F sustained over 60 minutes in a patient with an absolute neutrophil count (ANC) less than 500, or suspected drop below 500 within 48 hours) is relatively common oncologic emergency, particularly in hematologic malignancy patients. Expert consensus is that anti-pseudomonas gram-negative antibiotics (abx) should be administered within 60 minutes of detecting neutropenic fever.

At Thomas Jefferson University Hospital (TJUH), internal guidelines for time to treatment in neutropenic fever are in line with expert consensus - 60 minutes. We found that from July 1st – …

Analysis Of Alert Based Intervention On Management Of Hospital-Acquired Acute Kidney Injury: A Prospective Study, Amisha Ahuja, Md, Sonia Bharel, Md, Phil Durney, Md, Goni Katz, Md, Nicholas Tarangelo, Md, James Uricheck, Md, Randi Zukas, Md

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

Introduction

The development of acute kidney injury (AKI) during hospitalizations has become a widespread problem that leads to prolonged hospital stays and an increased risk of the development of renal failure. Several national prospective studies have been conducted to identify the most common causes of hospital acquired acute kidney injury (HAAKI) including contrast-induced, drug-induced, sepsis with hypotension, and comorbid organ dysfunction. To attempt to reduce HAAKI and its long-term consequences both to patients and the healthcare system, our study aimed to review creatinine changes among patients admitted to five general medicine teams. Our study goal was to see whether spreading …

Increasing Awareness For The Opioid Aftercare Coordination Service (Oacs), Michael Weintraub, Md, Harry Wang, Md, Sean Dikdan, Md, Mph, Alexys Monoson, Md, Shalini Krishnasamy, Jillian Zavodnick, Md

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

Background

• The United States is in a crisis of opiate related adverse events. From 1999 2017, more than 700,000 people in the U.S. died from drug related overdose; 68% of those involved opioids
• Admissions at Jefferson Hospital for opioid abuse complications are common among the medicine services. Treating patients for their opiate addiction is essential to prevent future opioid overdoses and other complications
• Jefferson has initiated an Opioid Aftercare Coordination Service (OACS) consult system in response to this crisis in order to increase the number of patients who receive medications for opioid use disorder on discharge
• OACS serves both Jefferson …

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

Optimizing Resident Clinic Efficiency Through Process Flow Analysis, Michael Abendroth, Md, Mba, Saumya Copparam, Md, Qiang Zhang, Phd, Rose Costello, Ma, Tara Uhler, Md, Robert Bailey, Md

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

Abstract

Introduction: Clinic process inefficiencies cause lengthy visit and wait times, which frustrate patients and providers and limit clinic capacity

Objective: To identify process inefficiencies and assess process flow interventions

Methods: Prospective, consecutive series of resident clinic visits over a 3-week period after transferring refraction from tech to resident. Personnel recorded the time spent waiting for and undergoing each clinic process. The clinic also piloted a “Fast Track” from registration to resident for appropriate established patients.

Results: Patients spent 53% of the visit waiting, primarily for the tech. Transferring refraction from tech to resident decreased the wait for tech …

Continuity Of Care In The Resected Pancreatic Cancer Patient Population At Thomas Jefferson University Hospital, Christian Fernandez, Md, Nazanin Sarpoulaki, Andrew J. Song, Md, Mark D. Hurwitz, Md

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

Introduction

• Standard of care for resectable pancreatic cancer according to the National Comprehensive Cancer Network guidelines includes surgery, chemotherapy, and consideration of radiotherapy
• Thomas Jefferson University Hospital is a high volume institution with over 100 surgical pancreatic cancer cases per year
• Adjuvant treatment at high volume centers is recommended at all stages and inpatients at TJUH routinely receive inpatient radiation and medical oncology consultations prior to discharge to discuss the benefit of adjuvant therapies
• Despite these efforts and potential benefit to patients, the rate of follow up and delivery of adjuvant therapies at TJUH have not be characterized
• We retrospectively …

Implementation Of A ‘Flow’ Attending Reduces Overall Ed Length Of Stay In Telehealth Intake Model, R. Fuega, K. Maloney, R. A. Band, B. H. Slovis, K. S. London, J. L. White

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

Background

In an effort to improve our efficiency, the Department of Emergency Medicine recently transitioned from an in person physician triage model to a telehealth intake model. With this change, many new gaps have been identified. By uncoupling triage from the in person intake provider, we lost the ability to manage “quick” discharges, to provide secondary oversight of the patients in the internal waiting room, and to directly supervise patients seen in the fast track area. In order to address these new concerns, and to mitigate the loss felt by removing the in person provider from intake, a ‘flow’ attending …

Time Outs Take Teamwork Improving Patient Safety For Bedside Procedures, Thana Theofanis, Md, Adam Johnson, Md, Mph, Jennifer Harris, Md, Elly Fitzpatrick, Rn, Darlene Rosendale, Rn, Rebecca Jaffe, Md

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

Aims for Improvement

Mission: Improve patient safety through increasing interprofessional collaboration and empowerment in the peri procedural time periods.

Aims

• Increase rate of high quality time outs performed prior to bedside procedures by 50%
• Increase rate of accurate and timely timeout documentation by 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.

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%.

We Got The Beat: Improving Cpr Quality With Real-Time Metrics, Juergen Kloo, Md, Frances Mae West, Md, Michael Haviland, Rn, Bsn

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

Introduction

High quality chest compressions have been linked to improved survival from sudden cardiac arrest.

The 2015 AHA guidelines recommend the following:

• Rate of compressions between 100 120 CPM
• Depth of compressions between 2 2.4 inches
• Allow full recoil between compressions
• Target CPR fraction at least 60% of the time, ideally 80%
• Avoid hyperventilation
• Collect and use data to improve performance

We set out to show that our clinicians would have a minimum 25% improvement in CPR quality with the use of real time feedback using the new R series ZOLL defibrillators.

Implementation Of A Volunteer Based Hospital Visitation Program For Older Adults, Mariana R. Kuperman, Md, Mph, Kristine Swartz, Md, Elizabeth Collins, Md, Jennifer Kim, Bs

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

Background

Hospital Elder Life Program (HELP)¹: a multi faceted, volunteer led, hospital based program has been shown to:

• Reduce the incidence of delirium
• Decrease length of stay
• Reduce hospital costs

Implementation of such a program requires upfront investment.

A smaller, volunteer based visitation program for older adults was started to provide support for the allocation of hospital resources in delirium prevention and establishment of HELP in this institution.

This research aims to investigate the program’s implementation and impact on delirium specific outcomes.

Evaluation Of A Text-Based Event Reporting Process On Resident Event Reporting Rates, R. B. Jones, C. L. Devin, D. Chalikonda, B. Menachem, R. Kanesa-Thasan, K. Klinger, B. Babula, R. Jaffe

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

Background

Voluntary event reporting is crucial to identify problem areas in healthcare. At TJUH, resident reporting from July to February during FY19 represented 2% of all report, compared to nursing who accounted for 77% of reports. Resident physicians witness events but do not report them due to cumbersome reporting platform, absence of feedback about reports, lack of reinforcement on how and what to report, and a mindset of not wanting to cause trouble (1,2). Our project aimed to lower the barrier of high administrative reporting burden for residents to report events by creating a HIPAA-compliant, mobile event reporting system.

Does Specific Labelling Of Chest Radiographs To Confirm The Position Of Peripherally Inserted Central Venous Catheters Decrease Turn Around Time?, Patrick Lee, Md, Maansi R. Parekh, Md, Paras Lakhani, Md, Achala Donuru, Md, Baskaran Sundaram, Md

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

Objectives

The primary objective of the current study was to decrease the turnaround time (TAT) of PICC CXRs. TAT was defined as the time from completion of the study to finalization of the report by the interpreting radiologist.

Reducing Double Chest Ct And Unnecesary Radiation: A Quality Improvement Project, Stephan S. Leung, Md, Mansi R. Parekh, Md, Achala Donuru, Md, Paras C. Lakhani, Md, Christopher G. Roth, Md, Baskaran Sundaram, Md

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

Objectives

To analyze the variables resulting in double chest CTs being ordered and performed, with the aim to reduce the amount of ordered double chest CTs at Thomas Jefferson University Hospital.

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.