Medicine and Health Sciences Commons^™

Implementation Of A Volunteer-Based Hospital Visitation Program For Older Adults, Jennifer Kim, Kristine Swartz, Md

Health Equity and Quality Improvement (HEQI) Summit

This research suggests that a volunteer program has a positive impact on hospital delirium, with longer visits having more effect.

Standardized Bronchoscopy Testing For Immunocompromised Patients, C. Nieweld, A. Gandler, K. Biblowitz, B. Menachem, J. Most

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Determine the consistency in which the order set was followed
• Determine the length of time from finding pulmonary infiltrate to consultation
• Determine the length of time from consultation to bronchoscopy
• Determine whether a follow up note was written by pulmonary
• Determine whether management is affected based on obtained results

Increasing Utilization Of Telehealth In Outpatient Primary Care, Allison Samuel, Md, Candace Derenge, Md, Anahita Molayi, Md, Amanda Kahn, Md, Jason Ojeda, Md

Health Equity and Quality Improvement (HEQI) Summit

Based on survey data, residents are interested in gaining exposure to Telehealth and attendings would like to increase their number of Telehealth appointments. Providers expressed uncertainty about insurance coverage as a major barrier to increasing Telehealth utilization.

SMART AIM: Increase the total number of Telehealth visits at JIMA by 25% and initiate Telehealth visits for residents by May 1st.

Improving Serial Imaging Protocols In Spontaneous Intracerebral Hemorrhage, Kevin Hines, Md, Nikolaos Mouchtouris, Md, Fadi Al-Saiegh, Md, Karim Hafazalla, Jacob Mazza, Giuliana Labella, Muhammad K. Athar, Md, Adam Flanders, Md, M. Reid Gooch, Md, Stavropoula Tjoumakaris, Md, Robert H. Rosenwasswer, Md, Pascal Jabbour, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Aim to decrease unnecessary use of serial imaging in sICH patients.

• This project plans to decrease the number of scans in this patient population while increasing faculty/staff satisfaction and efficiency of resource utilization.
• The goal is to decrease HCT utilization by 20% without compromising patient care or decision making.
• After finalizing and approving the HCT protocol, implementation of a trial period for two

Mitigation Of Ed Patient Boarding: Transferring Admissions From The Center City Ed To Methodist, Quinton Campbell, Md, Lauren Selame, Md, James Cirone, Do, Elizabeth Teixeira, Md, Jennifer White, Md, Frederick Randolph, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives:

• Objectively analyze transferred patient transfers cases as far as LOS (length of stay), final diagnosis, and transfer failure.
• Assess patient satisfaction with the transfer process as means to identify areas for improvement as well as potential patient safety issues.

Time To Defibrillation After Onset Of Ventricular Fibrillation And Ventricular Tachycardia Cardiac Arrest At Thomas Jefferson University Hospital And Jefferson Hospital For Neurosciences., Sairamya Bodempudi, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Improve average time to defibrillation after VFib/pVTach cardiac arrest to < 2 minutes within an 8 month interval at TJUH and JHN.
• Improve the percent of VFib/pVTach cardiac arrests that are defibrillated within the recommended 2 minute interval by 30% at TJUH/JHN within an 8 month interval

Exploring The Effectiveness Of Asthma Action Plans In Long-Term Asthma Management, Pankhuri Jha, Jessica Most, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Determine the efficacy of AAP in helping patients feel more confident in their self-management
• Improve asthma control by at least 10% after receiving an Asthma Action Plan

Experience With A Comprehensive Multidisciplinary Geriatric Oncology Center, Michael Weissberger, Md, Ms, Emma De Louw, Md, Kristine Swartz, Md, Lauren Hersh, Md, Andrew Chapman, Do, Facp

Health Equity and Quality Improvement (HEQI) Summit

Research Goals

1. 1. Describe the population seen in the SAOC over the past 6 years
2. Remediate and complete the EPIC flowsheets
3. Merge data with existing RedCAP data

Identifying Barriers To Statin Therapy In Diabetic Patients In A Large Ambulatory Practice, Jennifer Moyer, Md, Rachel Ehrman-Dupre, Md, Andrew Rabovsky, Md, Simon Newsom, Md, Pooja Padgaonkar, Md, Julita Mitchell, Md, Sarah Hirsh, Md, Madeline Taskier, Md, Robert Wiley, Md, Lilli Flink, Md, Greta Bires, Md, Geoffrey Mills, Md

Health Equity and Quality Improvement (HEQI) Summit

Aim 1: To understand the root cause(s) for gaps in statin therapy within a large ambulatory care practice.

Aim 2: To improve provider awareness of indications for statin therapy, as recommended by the ACC/AHA guidelines.

Aim 3: To increase the proportion of patients with diabetes at our practice that are on statin therapy.

Sglt2 Inhibitors In Patients With Diabetes And Cardiovascular Disease, Cristina Calogero, Md, Jillian Cooper, Md, Mathew Francis, Md, Joseph Grogg, Md, Shuwen Lin, Md, Patrick Prior, Md, Bo Hyung Yoon, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Problem Definition: Multiple studies (e.g. EMPA-REG, CANVAS) demonstrate that SGLT2 Inhibitors (Inh) improve cardiac outcomes in patients with Type II Diabetes (DM2) with comorbid Cardiovascular Disease (CVD) including Heart Failure and Coronary Artery Disease. SGLT2 Inhibitors are considered standard of care for patients with DM2 and CVD. Based on literature published in European Journal of Preventative Cardiology and JACC HF, our prediction is that physicians at Thomas Jefferson University Hospital Ambulatory Practices (TJUH) under-utilize SGLT2 Inh for patients with co-morbid CVD and DM2.

Aims for Improvement: Within the Jefferson Healthcare System, we sought to determine: Future Interventions

1. The percentage of …

Prevalence Of Gastrointestinal Symptoms In Patients With Cannabis Abuse Presenting To The Emergency Room, Hadiatou Barry, Md, Mph, Botros Shenoda, Md, Phd, Msc, Purujit Thaker, Md, Mary Naglak, Phd

Health Equity and Quality Improvement (HEQI) Summit

Introduction: Cannabis is a common recreational drug among young adults that is used to induce euphoria, promote relaxation and enhance appetite. There is a recognized correlation between cannabis abuse and cyclic episodes of nausea, vomiting, and abdominal pain (cannabinoid hyperemesis syndrome). However, the contribution of such symptoms to emergency room visits and hospital admissions is not known.

Methods: A one-year, retrospective study was conducted on patients who presented to the emergency department and were later admitted at Abington Hospital-Jefferson Health with confirmed cannabis use (positive urine drug screen).

Aim/Goal: Our primary outcome was to understand the prevalence of gastrointestinal symptoms …

Use Of Epic Emr For Early Identification And Management Of Patients At Risk Of Cardiac Implantable Electronic Device (Cied) Infection, Priya Rajagopalan, Md, Yair Lev, Md, Arnold J. Greenspon, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Aim of our project was early identification of 100% of patients with a CIED IMPLANT presenting with bacteremia
• Process involves use of EPIC EMR to automatically identify patients with positive blood cultures
• Traditionally, cardiologists are alerted by the care team using the CONSULT system for management of these patients
• EPIC EMR as an adjunct to the CONSULT system

Improving Evaluation And Follow-Up Of Patients Diagnosed With Left Bundle Branch Block, Naman Upadhyay, Md, Alvin George, Md, John Schanz, Ms, Behzad Pavri, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Left bundle branch block (LBBB) is a pathologic finding on electrocardiogram (ECG).

• Most commonly present in patients with antecedent hypertension, cardiac enlargement, coronary artery disease or a combination of these
• Class 1B recommendation: Those with findings of LBBB on ECG should undergo transthoracic echocardiography for evaluation of underlying heart disease
• LBBB is prevalent (33%) in patients with heart failure
• Cardiac resynchronization therapy can improve left ventricular mechanical function in patients with LBBB (QRS >150 msec)

This study aims to understand how effectively we are evaluating and following up these patients at Thomas Jefferson University Hospital.

The Echo Of An Unanswered Ring: Improving The Rate Of Reporting Abnormal Findings On Echocardiography At Tjuh, Tanuka Datta, Md, Bharaniabirami Rajaram, Md, Alvin George, Md, Madeleine Norris, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aim: To improve the rate of reporting abnormal echo findings verbally to primary patient care teams.

Goal: Increase the rate of attending reported abnormal echo findings to a patient's primary team by 75% in 6 months.

Improving Accuracy And Safety Of Inpatient Hypoglycemia Workup, Luis Arezeno, Md, Kimberly Lessard, Do, Eric Shiffrin, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

It is the aim of our quality improvement project to create a standardized method to appropriately assess and treat hypoglycemia in the inpatient setting such that the needed components of the diagnostic evaluation can be obtained in an expedited, cost-effective and patient safety-oriented manner.We plan to design of an inpatient hypoglycemia order set which can be used as an easily accessible reference and clinical tool.

Eliminating Unnecessary Premedications Before Outpatient Transfusions, Shraddha Patel Babariya, Md, Mary Harach, Bs, Mt(Ascp), Cqa(Asq), Ssgb, Joanne Filicko-O'Hara, Md, Lindsay Wilde, Md, Anne Delengowski, Rn, Msn, Alexis R. Peedin, Md, Julie Katz Karp, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Our aim is to eliminate premedication prior to outpatient transfusions in patients without a prior transfusion reaction by 75% within 1 year.

Does Discharge Pharmacy Affect Outcomes After Percutaneous Coronary Intervention?, Patrick Prior, Md, Lisa Moss, Abhinav Nair, Md, Preya Simlote, Md, David Fischman, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

To reduce the rate of this institution’s readmission rate in patients discharged after PCI, by identifying the current trends in readmission in relation to prescription and medication delivery practices over the past 1 year.

Clinical Outcomes Of Utilization Of Stress Ulcer Prophylaxis In Hospitalized, Non-Icu Patients, Paige Robinson, Do, Kate Radvanski

Health Equity and Quality Improvement (HEQI) Summit

Goal

This study is a retrospective chart review that aims to measure the effect of stress ulcer prophylaxis in hospitalized non-ICU level patients to determine the clinical effect of the presence or absence of stress ulcer prophylaxis.

Optimizing Evaluation And Treatment Of Patients With Nausea And Vomiting Of Pregnancy In The Emergency Department, Danielle N. Carr, Md, Angela Carracino, Do, Alisha Sangal, Md, Madeline Smith, Md

Health Equity and Quality Improvement (HEQI) Summit

Problem Definition

• Nausea and vomiting of pregnancy (NVP). Approximately 50% prevalence rate
• Pregnant patients with NVP require special considerations for treatment
• Long ER wait times
• Possibly avoidable hospital admissions

Improving Blood Pressure Control Through Blood Pressure Measurement In An Ambulatory Urban Family Medicine Clinic, Sara Ancona, Md, Zachary Klock, Md, Aimee Mcmullin, Md, Zeynep Uzumcu, Md, Olivia Seecof, Md, Graham Stratton, Md, Alexa Waters, Md, Caitlyn Haines, Md, Brittany Hozick, Md, Jose Medina, Md, Geoffrey Mills, Md, Phd

Health Equity and Quality Improvement (HEQI) Summit

Aim Statement: To increase the percentage of patients over the age of 18 with BP controlled to a goal of <140/90 from a baseline of 58% to 68% by April 2020.

Changing Internal Medicine Residents’ Perspective On Social Determinants Of Health, Daniel Tran, Do, Hiba Ansari, Do, Layla Barrera, Do, Magdala Chery, Do

Health Equity and Quality Improvement (HEQI) Summit

Background: Social determinants of health (SDOH) shape the conditions of a person’s daily life and include factors such as housing, occupation, education, safety and income. While physicians are aware of the inequalities that exists in healthcare, not all physicians feel adequately able to address such concerns. Understanding of factors that contribute to the development and perpetuation of inequities in health care must be developed at the medical education training level.

Objectives: Evaluate internal medicine residents’ understanding of SDOH and implement a curriculum on health disparities in order to improve their comfort in addressing social needs.

Methods: A survey regarding several …

Improving Inpatient Management Of Opioid Use Disorder, Yair Lev, Md, Darius Farzad, Md, Noah Haroian, Md, Jillian Zavodnick, Md

Health Equity and Quality Improvement (HEQI) Summit

Research Question: What aspects of successful OUD treatment teams are most needed at Thomas Jefferson?

Urine Drug Screening At The Sleep Disorder Center, Rohin Saroya, Md, Karl Doghramji, Md

Health Equity and Quality Improvement (HEQI) Summit

Aim

• Introduce UDS for all patients undergoing MSLT or MWT
• Eliminate false positive and negative results
• Optimize management of disorder

Goal

• To have 100% of patients undergoing an MSLT or MWT to have a UDS

Assessing Internal Medicine Resident Comfort With Obtaining Consent For Autopsies, Zach French, Kelly Hughes, Edward Wang, Elizabeth Braden

Health Equity and Quality Improvement (HEQI) Summit

Objective

We aim to increase resident comfort and knowledge of the autopsy process by 20% based on average survey response scores

Detection Of Coronary Artery Disease On Ct Chest Imaging, K. Mirzozoda, Md, Mba, J. Vojnika, Md, R. Mohammed, Md, H. Landon, Md, C. Murphy, Md, Y. Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Overall aim: Improve diagnosis and management of CAD based on CT chest imaging.

• Improve diagnosis of silent CAD based on CT chest imaging: more patients who have findings of CAC on CT chest imaging will be diagnosed with CAD.
• Increase the number of appropriate statin prescriptions based on CAD findings on CT chest imaging.

Time Value Analysis Of Inpatient Endoscopy Workflow, Sanaa Arastu, Md, Andrew Elden, Md, Raymond Janowski, Md, Aaron Martin, Md, Joseph Yoo, Md, Richard Denicola, Md, Amy Javia, Md, Melissa Vitolo, Md, Linda Yan, Md, Christopher Cao, Md, Scott Manski, Md, Christopher Schmoyer, Md, Brianna Shinn, Md, Mitchell Conn, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Our aim was to evaluate the variables involved in room turnover and identify any delays that lead to the time difference found between inpatient and outpatient rooms.
• We planned to design an intervention to improve efficiency in the endoscopy suite and complete more inpatient cases.
• We predicted that completion of more inpatient cases would subsequently decrease the need for cancellation and rescheduling of medically necessary cases on a daily basis.

You're In Great Hands: Building Inter-Professional Relationships To Build Confidence In Patient Referrals, Erin Kelly, Do, Kristofer Feeko, Do

Health Equity and Quality Improvement (HEQI) Summit

Objective

To increase inter-professional relationships and know at least one physician within each different specialty so that they can confidently refer patients to them and trust that it will be a good experience for the patient by knowing them personally and professionally by the end of the 2020-2021 academic year.

A Rare Case Report And Literature Review Of Anabolic-Androgenic Steroids (Aas)-Induced Acute Myocardial Infarction, Qian Zhang, Khine S. Shan, Ahmad Raza, Neelima Manda, Travis Nace

Abington Jefferson Health Papers

Anabolic-androgenic steroids (AAS) are synthetic drugs manufactured to mimic the male sex hormone testosterone [1]. They are usually prescribed for medical conditions including but not limited to impotence in males, endometriosis, hypogonadism, and aplastic anemia [2]. It has also been used historically by athletes and bodybuilders to enhance performance as it can stimulate protein synthesis leading to an increase in muscle size and strength [3]. However, the use of AAS has become a serious global public health dilemma as it has been used widely by the general population to improve physical strength and appearance [1]. In …

Outcomes Of Open Mitral Valve Replacement Versus Transcatheter Mitral Valve Repair; Insight From The National Inpatient Sample Database., Waqas Ullah, Yasar Sattar, Maryam Mukhtar, Hafez M. Abdullah, Vincent M. Figueredo, Donald C. Haas, David L. Fischman, M. Chadi Alraies

Abington Jefferson Health Papers

Background: Transcatheter mitral valve repair and replacement (TMVR) is a minimally invasive alternative to conventional open-heart mitral valve replacement (OMVR). The present study aims to compare the burden, demographics, cost, and complications of TMVR and OMVR.

Methods: The United States National Inpatient Sample (US-NIS) for the year 2017 was queried to identify all cases of TMVR and OMVR. Categorical and continuous data were analyzed using Pearson chi-square and independent t-test analysis, respectively. An adjusted odds ratio (aOR) based on the ordinal logistic regression (OLR) model was calculated to determine the association between outcome variables.

Results: Of 19,580 patients, 18,460 …

A Fatal Case Of Primary Amoebic Meningoencephalitis From Recreational Waters., Edward Hamaty, Saif Faiek, Minesh Nandi, David Stidd, Manish Trivedi, Hari Kandukuri

Department of Neurosurgery Faculty Papers

Background: Naegleria Fowleri is a single-cell, thermophilic amphizoid amoeba, and a rare known causative agent for primary amoebic meningoencephalitis with >97% mortality rate. The amoeba resides in freshwater lakes and ponds but can also survive in inadequately chlorinated pools and recreational waters. The mode of infection includes activities such as diving or jumping into freshwater or submerging the head under the water. Although most commonly seen in the southern United States, it is essential to keep this clinical suspicion in mind regardless of geography, as presenting symptoms can be very similar to classic bacterial meningitis.

Conclusion: As per the CDC, …