Medicine and Health Sciences Commons^™

Implementation Of A Volunteer-Based Hospital Program For Older Adults, Elizabeth Collins, Md, Kristine Swartz, Md

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

Background

• A multi-faceted, volunteer-led, hospital-based program1has been shown to: •Reduce the incidence of delirium •Decrease hospital length of stay •Reduce hospital costs.
• Implementation of such a program requires upfront investment.
• A smaller, volunteer-based visitation program for older adults may provide support for the allocation of more hospital resources in delirium prevention and establishment of a formal Hospital Elder Life Program1in this institution.
• This research aims to investigate: •If the implementation of a visitation program is feasible at this hospital •Volunteer experience with the program.

Improvement In Patient Safety Through “Irrigation Time-Outs” During Turp Procedures, B. L. Deiling, Do, E. Kilmartin, Md, T. L. Kennedy, Md

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

Objective

During any surgical procedure, clear and standardized communication among surgeons, anesthesiologists and operating room nursing staff is a necessity for all aspects of patient safety. During TURP procedures, the perioperative staff must alert team members of the signs and predictors for the potential of TURP syndrome or NSS overload. The goal of our quality improvement project is to increase communication and diagnostic actions based on irrigation fluid amounts among surgeons, anesthesiologists, and the operating room nurses in order to decrease complications in TURP patients at Jefferson over the next six months.

Handoff Training In Undergraduate Medical Education – Identifying And Closing The Gaps, Gregory Troutman, Jeffery Head, Andrew Day, John Hafycz, Lauren E. Grunenwald, Kelly Daniels, Kevin He, Rebecca Montana, Alexis Wickersham, Md

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

Objectives:

• Our study sought to assess differences in perceptions and the use of standardized handoff tools between medical students near completion of their third and fourth years of medical school at Sidney Kimmel Medical College.
• We hope to use this information to create targeted medical education interventions to better expose pre-clinical medical students to standardized handoff tools in the first and second years of medical school, before entering the wards.

The Effects Of Office-Based Interventions To Increase Patient Enrollment In An Online Electronic Medical Record Portal, Lionel Mcintosh, Md, Allison Rague, Md, Claire Thesing, Md, Amy Lachewitz, Md, Gillian Love, Md, Daniel Sizemore, Md, Zachary Klock, Md, Aimee Mcmullin, Md, Zeynep Uzumcu, Md, Patrick Mcmanus, Md

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

We aimed to increase the number of JFMA patients signed up with MyChart by 50% over a 5 month time frame by educating providers and staff on ways to implement patient portal sign up into the office visit as well raising awareness of the portal for both providers and patients

Bad Out Of The Box: A Report On Pre-Operative Failure Rates Of Reusable Flexible Ureteroscopes At A Single Institution, Whitney R. Smith, Brian P. Calio, Scott G. Hubosky, Kelly A. Healy, Demetrius H. Bagley

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

Purpose: Single-use flexible ureteroscopes offer the advantage of being consistently functional and perfect for immediate clinical use right “out of the box.” Cost is the barrier to widespread acceptance of these instruments. Economic models have been put forth which compare the expense of acquiring and maintaining reusable flexible ureteroscopes to that of using single-use flexible ureteroscopes.However, one poorly defined variable in these models is the frequency of encountering an unsuitable reusable flexible ureteroscope at the beginning of a case. We sought to define this in a consecutive series of patients undergoing flexible ureteroscopy.

Patients and Methods: Prospective analysis of all …

Awareness During An Intensive Care Unit Procedure: A Root Cause Analysis And Creation Of The D5 Handoff Tool, Elise Strickler, Do, Bryan Lutman, Do

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

Objectives

The objectives of this study are to:

1. perform root cause analysis of the systemic causes of an incident of awareness that occurred during bedside EGD and
2. create a handoff tool that is easily remembered that conveys the essential information about ICU intubations.

Utilizing Feedback As A Mechanism To Improve Resident Event Reporting Rates, Grant Turner, Md, Kristin Lohr, Md, Ben Jones Jr., Md, Emma Lundsmith, Md, Megan Margiotta, Md, Riti Kanesa-Thasan, Md, Bracken Babula, Md, Rebecca C. Jaffe, Md

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

Objectives

• Provide feedback to 100% of residents entering a report between December 2017 and March 2018
• Evaluate the degree to which residents value the feedback we were able to provide
• Assess a pilot process for sustainability on a larger scale

Get With The Rhythm – Telemetry Education In Internal Medicine Residency, Rashesh Shah, Md, Hanna Sofie Ellingsen, Md, Molly Halloran, Md, Reetu Mukherji, Md, Juergen Kloo, Md, Yair Lev, Md

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

Aim

• Our aim was to design and implement cardiac monitoring education for medical residents in order to help residents feel more comfortable navigating and assessing telemetry.
• Our objective was to create and pilot a telemetry education video among Internal Medicine residents (from March to May 2018) resulting in a 75% increase in ability to demonstrate essential telemetry skills as determined by a pre and post video assessment.

Prevention And Screening Of Vte In Sci Patients At Thomas Jefferson University Hospital, Erika Dillard, Md, Phd, Yusef Mosley, Md, Joshua Marks, Md, Christina Jacovides, Md, Geoffrey Ouma, Md, James Harrop, Md

Department of Neurosurgery Posters

Currently no protocol exists for thromboprophylaxis (TPx) and screening in SCI patients at TJUH. As such, often patients are either not started on TPx or are started on an inappropriate regimen depending on admitting team preference. In addition, patients often receive an admission DUS then weekly thereafter as a screening mechanism for DVT even if asymptomatic.

Our goal is to determine the effectiveness of our current method for initiating pharmacological TPx as well as efficacy and cost of our current screening method compared to national guidelines by addressing these questions:

• What is the occurrence of VTE in SCI patients at …

Atrx Mutation In Pineal Parenchymal Tumor Of Intermediate Differentiation, Michelle Nagurney, Md, Christopher Farrell, Md, Zi-Xuan Wang, Phd, Mark T. Curtis, Md

Department of Pathology, Anatomy, and Cell Biology Posters

Objectives

Based on our identification of an ATRX mutation in a PPTID of a 22 year old female, we analyzed the frequency of ATRX loss in pineal parenchymal tumors using ATRX immunohistochemical staining.

The Use Of Online Cbt-I At Jefferson Sleep Disorder Clinic: A Quality Improvement Study, Kathy Tran, Do, Ritu Grewal, Md

Department of Sleep Medicine Posters

Objectives

We propose to introduce online CBT-I into our patient practice by distributing flyers to patients who complain of insomnia. We have made flyers available in all the exam rooms and educated physicians, nurse practitioners and staff. We will then review charts after the intervention period to evaluate for an increase in recommendation for CBT-I as a treatment option and education for patients.

Improving Follow-Up For Family Medicine Patients After Hospital Discharge, Erica Li, Md, Rebecca Simon, Md, Michael Weissberger, Md, Angela Silverman, Md, Mpg, Bryan Botti, Md, Laura Emerson, Md, Zoe Agoos, Md, Rachel Ehrman-Dupre, Md, Jennifer Moyer, Md, Andrew Rabovsky, Md, Geoffrey Mills, Md, Phd

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

Aims

• Increase percentage of JFMA patients with follow-up appointment scheduled after discharge to 100% by March 2018
• Increase percentage of JFMA patients who show up to their follow up appointments after discharge to 80% by March 2018

The ‘Med History Note’: A Standardized Method Of Reducing Medication History Errors Among Internal Medicine Residents In A Teaching Hospital, Odunayo Banjoko, Md, Babatunde Ogunnaike, Md, Genene Amoia-Pigliacelli, Pharmd, Doron Schneider, Md

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

Problem Statement

According to the institute of medicine’s preventing medication errors report, the average hospitalized patient is subject to at least one medication error per day. Errors have been known to occur during admission, transfer and discharge of patients. An accurate medication history on admission is crucial and can go a long way in preventing medication reconciliation errors. Of note, more than 40% of medication errors occur from inadequate reconciliation, during admission, transfer and discharge of patients. Of these, 20% result in harm.

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.

Central Line Cart: An Emergency Department Initiative To Improve Efficiency, M. Ahmed, Md

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

Background

• Critically ill patients that present to the emergency room often require time sensitive resuscitative measures, which often necessitates placement of a central venous catheter.
• Efficient placement of a central venous catheter is often limited by the time it takes to gather the number of supplies needed for the task.
• It is already known that central venous catheter procedure carts and kits decrease the incidence of central line associated bloodstream infections (CLABSIs)1 as well as reduce the incidence of procedural mistakes during central line insertion2
• However, there is a paucity of data in regards to the impact of central line …

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.

Adaptation Of A Standardized Handoff System For A Radiology Residency Program, Riti Kanesa-Thasan, Md, Liya Gendler, Md, Megan Margiotta, Md, Kristin Lohr, Md, Grant Turner, Md, Rebecca C. Jaffe, Md, Christopher G. Roth, Md, Suzanne Long, Md

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

Background/Objectives:

• The Joint Commission has linked communication failure as a root cause for a majority of sentinel events.
• The “I-PASS” system is a hand-off mnemonic that has been shown to decrease medical errors, prevent adverse events, and improve communication.
• Multiple Jefferson residency programs have adopted I-PASS training over the last year to standardize sign-outs between treatment teams and departments.
• Radiology residents also participate in hand-offs with other departments, especially in cases of adverse patient reactions that occur within radiology (ie: allergic reaction, seizure, contrast extravasation). In addition, radiology residents also participate in hand offs between daytime and overnight teams, including …

A Novel Diabetes Elective Course For Pharmacy Students, Amy M. Egras, Pharmd, Bcps, Bc-Adm

College of Pharmacy Posters

Course Description & Objectives

The Diabetes Immersion elective is a 2-credit hour course offered to pharmacy students in their 3rd year of pharmacy school.

1. Demonstrate empathy regarding the impact of diabetes on everyday life.
2. Demonstrate the ability to monitor blood glucose, count carbohydrates, inject “insulin”, and adjust insulin dose based on daily experiences.
3. Discuss the impact of mental health and sociobehavioral/cultural aspects on diabetes.
4. Develop and provide diabetes education to the community.

Effect Of Manual Over Scoring On Automated Analysis Of Level 3 Home Sleep Testing (Hst) Results, Theodora Fynn, Ritu Grewal, Karl Doghramji, Prakash Vasudevan, Tingting Zhan

Department of Sleep Medicine Posters

No abstract provided.

Treatment Of Obstructive Sleep Apnea With Maxillo-Mandibular Advancement Surgery: Evaluation And Predictors Of Success, Daniel Taub, Dmd, Md, Michael Courtney, Dmd, Md, Karl Doghramji, Md

Department of Oral and Maxillofacial Surgery Posters

Obstructive sleep apnea (OSA) is a well-recognized disease entity affecting approximately 2% to 4% of the population. Maxillomandibular advancement (MMA) surgery is a highly successful surgical alternative to poorly tolerated CPAP therapy and achieves a success rate of 89% in the current literature. Our present study evaluates the effectiveness of MMA surgery in the treatment of patients with moderate to severe OSA based on Shers criteria of 50% reduction in AHI and AHI < 20. Radiographic and clinical treatment variables were evaluated in determining predictors of success for MMA in individuals with OSA.

Does Transition From Cpap To Bipap Improve Symptoms Of Aerophagia?, Kathy Tran, Do, Karl Doghramji, Md

Department of Sleep Medicine Posters

Introduction

Adherence to continuous positive airway pressure (CPAP) therapy has been an ongoing dilemma in obstructive sleep apnea patients and up to 83% of patients are noncompliant. It is believed that mask discomfort or pressure intolerance are the major causes. Aerophagia, or “air swallowing” may be an under-recognized and insidious cause for CPAP nonadherence. Patients generally complain of belching, bloating, abdominal pain and distention. Some studies have reported worsening gastrointestinal reflux symptoms from PAP-induced aerophagia. Although bi-level positive airway pressure (BIPAP) is often utilized in such circumstances, this practice had not been examined. We hypothesized that transitioning patients from CPAP …

A Bibliometric Analysis Of The Top 100 Cited Articles On Hepatic Magnetic Resonance Imaging., Waqas Ullah, Hafez Mohammad A. Abdullah, Ejaz Ahmad, Mamoon Ur Rashid, Muhammad Bashir, Asad Ur Rahman, Asrar Ahmad, Abu Hurairah

Abington Jefferson Health Papers

The purpose of this study is to guide the readers to the impact of the articles published on hepatic magnetic resonance imaging (MRI). We searched Scopus using 10 different search terms for hepatic MRI. The selected studies were thoroughly reviewed by two independent authors and any disagreement was sorted out by mutual consensus. The list of articles and journals was downloaded into an excel spreadsheet. Only the top 100 cited articles were selected by mutual consensus among all the authors. These articles were further read in the full-text form and were further categorized into subgroups. Three authors independently reviewed the …

A Word From The Writing Team (June 2018), Jennifer Wilson, Ms, Els

A Word From the Writing Team (Newsletter)

This issue includes:

• Sign Up for Our Fall Writing Retreat
• Grammarly Pro
• New eBook on Communicating Data Clearly
• Writing Café

Use Of International Classification Of Diseases, Ninth Revision Codes For Obesity: Trends In The United States From An Electronic Health Record-Derived Database., Michelle Mocarski, Ye Tian, B. Gabriel Smolarz, John Mcana, Albert Crawford

College of Population Health Faculty Papers

Obesity is a potentially modifiable risk factor for many diseases, and a better understanding of its impact on health care utilization, costs, and medical outcomes is needed. The ability to accurately evaluate obesity outcomes depends on a correct identification of the population with obesity. The primary objective of this study was to determine the prevalence and accuracy of International Classification of Diseases, Ninth Revision (ICD-9) coding for overweight and obesity within a US primary care electronic health record (EHR) database compared against actual body mass index (BMI) values from recorded clinical patient data; characteristics of patients with obesity who did …

Injuries In The Chinese Arena Football League: American Versus Chinese Players., Tianwu Chen, Austin Wetzler, Scott Singer, Michael Feldman, David Rubenstein, Gunnar Gillespie, Shiyi Chen, Merrick Wetzler

Rothman Institute Papers

Background: Arena football is an indoor version of American football played in indoor arenas on a smaller field with 8 players per team. Only 1 study has evaluated injury rates in arena football, and no study had compared 2 distinct cohorts of players.

Purpose/Hypothesis: The purpose of this study was to evaluate and compare injury rates in American versus Chinese athletes in the Chinese Arena Football League. Our hypothesis was that the rate of significant injuries (≥7 days of time lost from play) would be statistically significantly higher in Chinese athletes.

Study Design: Cohort study; Level of evidence, 2.

Methods: …

Additive Drug-Specific And Sex-Specific Risks Associated With Co-Use Of Marijuana And Tobacco During Pregnancy: Evidence From 3 Recent Developmental Cohorts (2003-2015)., Suena H Massey, Daniel K Mroczek, David Reiss, Emily S Miller, Jessica A Jakubowski, Eileen K Graham, Shannon M Shisler, Meaghan Mccallum, Marilyn A. Huestis, Jody M Ganiban, Daniel S Shaw, Leslie D Leve, Rina D Eiden, Laura R Stroud, Jenae M Neiderhiser

Institute of Emerging Health Professions Faculty Papers

BACKGROUND: Methodologic challenges related to the concomitant use (co-use) of substances and changes in policy and potency of marijuana contribute to ongoing uncertainty about risks to fetal neurodevelopment associated with prenatal marijuana use. In this study, we examined two biomarkers of fetal neurodevelopmental risk-birth weight and length of gestation-associated with prenatal marijuana use, independent of tobacco (TOB), alcohol (ALC), other drug use (OTH), and socioeconomic risk (SES), in a pooled sample (N = 1191) derived from 3 recent developmental cohorts (2003-2015) with state-of-the-art substance use measures. We examined differential associations by infant sex, and multiplicative effects associated with co-use of …

A Systematic Review Of The Efficacy Of Weighted Vests And Blankets On People With Asd Or Adhd, E. Denny, W. Folkes, I. Ghattas, H. Kaufmann, H. Williams, Marie-Christine Potvin

Student Papers, Posters & Projects

Sensory-based treatment methods are commonly used by occupational therapists and others working with individual with ADHD and ASD (Wan Yunus, Liu, Bissett, & Penkala, 2015). Weighted vests or weighted blankets are popular sensory-based interventions used with people with these conditions. Weighted vests and weighted blankets are widely reported to have various benefits and positive outcomes with children with these conditions (Shulman, 2018). They are thought of as providing deep pressure that is reported to help clients self-regulate, diminish episodes of maladaptive behavior and anxiety or stress, and improve attention, sleep, and mood (Shulman, 2018). A series of systematic reviews have …

Cognitive Orientation To (Daily) Occupational Performance (Co-Op) Approach And Children With Disabilities, E. Amidon, K. Matteo, K. O'Toole, C. Pistilli, A. Slomowitz, Marie-Christine Potvin

Student Papers, Posters & Projects

There is a growing body of research evidence for the CO-OP approach since first published in 2001. Individual studies such as single case designs have found positive outcomes using this approach, however, no prior systematic reviews exist. Therefore, this review aims to compile and evaluate the efficacy of the CO-OP approach in children with disabilities.

A Rare Case Of Clostridium Septicum Aortitis With Colon Adenocarcinoma, Niti Shahi, Mariano Arosemena, Jeontaik Kwon, Paul J. Dimuzio, Babak Abai, Dawn M. Salvatore

Department of Surgery Faculty Papers

Clostridium septicum aortitis is a rare, highly morbid condition typically accompanied by malignant disease, such as hematologic cancer or colon adenocarcinoma. Presenting symptoms commonly described include acute onset of abdominal pain, nausea, and fevers. Prompt diagnosis of infectious aortitis is critical to prevent deadly complications, such as sepsis and vascular catastrophe. The described management largely involves surgical resection of the infected aorta, débridement, and arterial revascularization through extra-anatomic bypass or aortic graft placement.

Pepducins As A Potential Treatment Strategy For Asthma And Copd., Reynold A. Panettieri, Tonio Pera, Stephen B B. Liggett, Jeffrey L. Benovic, Raymond B. Penn

Center for Translational Medicine Faculty Papers

Current therapies to treat asthma and other airway diseases primarily include anti-inflammatory agents and bronchodilators. Anti-inflammatory agents target trafficking and resident immunocytes and structural cells, while bronchodilators act to prevent or reverse shortening of airway smooth muscle (ASM), the pivotal tissue regulating bronchomotor tone. Advances in our understanding of the biology of G protein-coupled receptors (GPCRs) and biased agonism offers unique opportunities to modulate GPCR function that include the use of pepducins and allosteric modulators. Recent evidence suggests that small molecule inhibitors of Gα _q as well as pepducins targeting G _q -coupled receptors can broadly inhibit contractile agonist-induced ASM …