Medicine and Health Sciences Commons^™

Upgrading A Social Media Strategy To Increase Twitter Engagement During The Spring Annual Meeting Of The American Society Of Regional Anesthesia And Pain Medicine., Eric S. Schwenk, Kellie M. Jaremko, Rajnish K. Gupta, Ankeet D. Udani, Colin J J.L. Mccartney, Anne Snively, Edward R. Mariano

Department of Anesthesiology Faculty Papers

Microblogs known as "tweets" are a rapid, effective method of information dissemination in health care. Although several medical specialties have described their Twitter conference experiences, Twitter-related data in the fields of anesthesiology and pain medicine are sparse. We therefore analyzed the Twitter content of 2 consecutive spring meetings of the American Society of Regional Anesthesia and Pain Medicine using publicly available online transcripts. We also examined the potential contribution of a targeted social media campaign on Twitter engagement during the conferences. The original Twitter meeting content was largely scientific in nature and created by meeting attendees, the majority of whom …

Expanding The Genotypic Spectrum Of Bathing Suit Ichthyosis., Nareh V. Marukian, Rong-Hua Hu, Brittany G. Craiglow, Leonard M. Milstone, Jing Zhou, Amy Theos, Hande Kaymakcalan, Deniz A. Akkaya, Jouni J. Uitto, Hassan Vahidnezhad, Leila Youssefian, Susan J. Bayliss, Amy S. Paller, Lynn M. Boyden, Keith A. Choate

Department of Dermatology and Cutaneous Biology Faculty Papers

Importance: Bathing suit ichthyosis (BSI) is a rare congenital disorder of keratinization characterized by restriction of scale to sites of relatively higher temperature such as the trunk, with cooler areas remaining unaffected. Fewer than 40 cases have been reported in the literature. Bathing suit ichthyosis is caused by recessive, temperature-sensitive mutations in the transglutaminase-1 gene (TGM1). Clear genotype-phenotype correlations have been difficult to establish because several of the same TGM1 mutations have been reported in BSI and other forms of congenital ichthyosis. We identify novel and recurrent mutations in 16 participants with BSI.

Objective: To expand the genotypic spectrum of …

Findings Of Cognitive Impairment At High Altitude: Relationships To Acetazolamide Use And Acute Mountain Sickness., Lara Phillips, Buddha Basnyat, Yuchiao Chang, Erik R. Swenson, N. Stuart Harris

Department of Emergency Medicine Faculty Papers

Phillips, Lara, Buddha Basnyat, Yuchiao Chang, Erik R. Swenson, and N. Stuart Harris. Findings of cognitive impairment at high altitude: relationships to acetazolamide use and acute mountain sickness. High Alt Med Biol. 18:121-127, 2017.

OBJECTIVE: Acute mountain sickness (AMS) is defined by patient-reported symptoms using the Lake Louise Score (LLS), which provides limited insight into any possible underlying central nervous system (CNS) dysfunction. Some evidence suggests AMS might coexist with altered neural functioning. Cognitive impairment (CI) may go undetected unless a sensitive test is applied. Our hypothesis was that a standardized test for mild CI would provide an objective measure …

Molecular-Based Recursive Partitioning Analysis Model For Glioblastoma In The Temozolomide Era: A Correlative Analysis Based On Nrg Oncology Rtog 0525., Erica Hlavin Bell, Stephanie L Pugh, Joseph P. Mcelroy, Mark R. Gilbert, Minesh Mehta, Alexander C Klimowicz, Anthony Magliocco, Markus Bredel, Pierre Robe, Anca L. Grosu, Roger Stupp, Walter Curran, Aline P. Becker, Andrea L. Salavaggione, Jill S. Barnholtz-Sloan, Kenneth Aldape, Deborah T. Blumenthal, Paul D. Brown, Jon Glass, Luis Souhami, R. Jeffrey Lee, David Brachman, John Flickinger, Minhee Won, Arnab Chakravarti

Department of Neurosurgery Faculty Papers

Importance: There is a need for a more refined, molecularly based classification model for glioblastoma (GBM) in the temozolomide era.

Objective: To refine the existing clinically based recursive partitioning analysis (RPA) model by incorporating molecular variables.

Design, Setting, and Participants: NRG Oncology RTOG 0525 specimens (n = 452) were analyzed for protein biomarkers representing key pathways in GBM by a quantitative molecular microscopy-based approach with semiquantitative immunohistochemical validation. Prognostic significance of each protein was examined by single-marker and multimarker Cox regression analyses. To reclassify the prognostic risk groups, significant protein biomarkers on single-marker analysis were incorporated into an RPA model …

Should We Set A Formalized Discharge Instruction Education Standard?, Jinyu Zhang, Md, Maria Vershvovsky, Md, Noha Ghusson, Md, Jeffrey Riggio, Md, Lily Ackermann, Md

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

Smart AIM:

With a more formalized discharge instruction evaluation process for PGY-1s, discharge instructions for specific diagnoses will have less error in a year’s time.

Vaginal Preparation With Povidone Iodine Prior To Cesarean Delivery, Laura Felder, Md, Amanda Paternostro, Md, Johanna Quist-Nelson, Md

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

Objectives: To reduce the rate of postoperative endometritis in patients undergoing cesarean delivery by implementing a new departmental guideline for vaginal preparation prior to cesarean sections, after labor or rupture of membranes

Utilization Of A Multimodal Preoperative Pain Regimen Prior To Gynecologic Oncology Exploratory Laparotomies, Lauren C. Hand, Md, Alison Vogell, Md, Talia Maas, Md, Kristina Masi, Md, Rebecca J. Mercier Md Mph, Norman G. Rosenblum, Md, Phd, Christine H. Kim, Md

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

Objective:

The aim of this study was to evaluate the use of a combination of non-opioid preoperative pain medications including Tylenol, Lyrica, and Celecoxib (TLC) in patients undergoing gynecologic oncologic exploratory laparotomies. We evaluated postoperative narcotic use in morphine equvalents (ME) as well as pain scores, anti-emetic use, and length of stay.

Quiet In The Operating Room! Team Stepps And Or Distractions, Zabecca S. Brinson, Md, Adam P. Johnson, Md, Mph, Rose Farmer, Rn, Tesa Leonard, Crna, Susan Cacciatore, Rn, Maritza Sanchez, Rn, Lorie Weikel, Rn, Paul Sammut, Rn, Francesco Palazzo, Md

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

Background and Objective:

From the moment that a patient enters the operating room to the time that they are brought to the post anesthesia care unit, a distraction has the potential to lead to an adverse outcome for the patient. During the critical portions of the surgery, it is even more important for all members of the operating staff to be focused and engaging in safe practices. Distractions in the operating room can hinder safe communication and potentially endanger patient safety. Team training has been shown to both improve team communication and reduce distractions.

The objective of this project was …

Transrectal Ultrasound Guided Prostate Biopsy Antibiotic Prophylaxis: Standard Vs. Augmented Antibiotic Regimens, And The Role For Pre-Biopsy Rectal Swab Cultures, Thomas Hardacker, Md, Mba, Danielle Squadrito, Rn, Christopher Caputo, Md, Mark Mann, Md

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

Objectives:

To evaluate peri-procedural antibiotic prophylaxis regimens based on pre-procedural rectal swab cultures.

To evaluate infection rates between transrectalbiopsy patients receiving FQs alone and those receiving ceftriaxone or gentamicin in addition to FQs.

Inappropriate Electrolyte Repletion For Patients Undergoing Endoscopic Procedures, Daniel Altman, Md, Solomon R. Dawson, Md, Kevin Kwak, Md, Drew Johnson, Md, Harshal Mehdi, Md, Christie Mulholland, Md

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

At Thomas Jefferson University Hospital (TJUH), there has been a perceived necessity among housestaff and fellows to routinely check and replete serum potassium and magnesium for inpatients prior to endoscopic procedures In addition, there was an unwritten policy that these electrolytes needed to be aggressively repleted, with a goal potassium above 4.0 and magnesium above 2.0 Contributing factors include absence of clear policy, fear of adverse outcomes during procedures, and fear of delay of procedures leading to increased hospital stay This practice has led to unwarranted lab draws, costs of lab tests and electrolyte riders, and possible delayed procedures

Goals …

Standardization Of Monofilament Use In A Resident-Run Clinic, Odunayo Banjoko, Md, Doron Schneider, Md

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

Study Aim:

The aim of this study was to improve incidence of regular foot exams among clinic diabetic patients.

Preventing Isolated Perioperative Reintubation: Who Is At Highest Risk?, Tyler M. Bauer, Md, Adam P. Johnson, Md, Chris Wirtalla, Md, Jordan E. Goldhammer, Md, Rachel R. Kelz, Md, Scott W. Cowan, Md

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

Objectives:

1. We aim to characterize IPR nationally through a retrospective review of the National Surgical Quality Improvement Program participant user file (NSQIP PUF).

2.Identify risk factors for IPR including analysis of procedure type and preoperative characteristics.

Echocardiography Role In Syncope Patients, Ali Raza Ghani, Md, Irfan Ahsan, Md, Wajahat Humayun, Md, Usman Sarwar, Md, Margot I. Boigon, Md, Mary Maglak, Phd

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

Methods: We did a retrospective chart review of 138 patients admitted to observation floor with diagnosis of syncope.

Improving Resulted Hemoglobin A1c Rates: A Feasibility Study For Point-Of-Care Hemoglobin A1c Testing At An Urban Family Medicine Office, Phoebe Askie, Md, Mph, Daniel Chung, Md, Laura Parente, Md, Yury Parra, Md, Grace Amadi, Md, Mariana R. Kuperman, Md, Mph, Bruce Reaves, Md, Miranda Aragon, Md, Kyle Bardet, Md, Sunny Lai, Md, Anna Woods, Md, Marc Altshuler, Md

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

Study Aims:

• Our practice’s goal is to increase the number of up to date hemoglobin A1c for diabetic patients seen at JFMA in order to help improve glycemic control
• The aim of this study is to see if point of care (POC) hemoglobin A1C is a feasible way to increase the number of up to date hemoglobin A1C. We looked at various factors including timing, training, and flow.

"The Weekend Effect": Weekday Versus Weekend Comparison Of Patients Admitted With Nstemi In Terms Of Length Of Hospital Stay, Door To Balloon Time And Left Ventricular Function, Wajahat Humayun, Md, Ali Raza Ghani, Md, Asoka Balaratna, Md, Mary Naglak, Phd

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

The primary objective of our study was to determine the difference in the outcome, if any, between patients presenting with NSTEMI on weekends versus weekdays. We also looked for the difference in clinical outcomes between these two groups of patients.

Poster presented at annual House Staff Quality Improvement and Patient Safety Posters.

The Case Of The 10 Pound Giant: A Near Miss Root Cause Analysis, Debbie Chen, Md, Megan Margiotta, Md, Grant Turner, Md

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

Objectives:

Through an Interprofessional Root Cause Analysis of this Near Miss event, we aimed to: 1.Identify issues contributing to the incorrect dosing of acyclovir 2.Understand relevant institutional policies and compare this to usual practice 3.Propose possible solutions

Got Sugar? Pharmacist Intervention To Improve A1c, Rino Sato, Md, Matthew Murphy, Md, Margaret Ivanov, Md, Alan Gandler, Md, Roshni S. Patel, Pharmd, Bcps, John Caruso, Md, Loren Chen, Md, Albert Lee, Md

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

AIM:

Within 6 months, we aim to decrease by 10% the number of our diabetic patients with an A1c >8 through Clinical Pharmacist referrals.

Improving Colon Cancer Screening In A Resident Ambulatory Clinic, Newton Mei, Md, Grace Yang, Md, Mital Shah, Md, Albert Lee, Md

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

AIM Statement:

Our aim at Wednesday JHAP was to increase the rate of colorectal cancer screenings from 44.3% to 60% from September 2016 to May 2017 (9 months)

Improving Pneumococcal Vaccination Rates In Jefferson Hospital Ambulatory Practice Patients, Kemarut Laothamatas, Md, Linda Yan, Md, Daniel Kramer, Md, Matthew Enriquez, Md

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

AIM:

To improve the pneumococcal vaccination initiation rates in patients 65 years and older in Jefferson Hospital Ambulatory Practice (JHAP) to the institutional quality measure goal of 80% over a 4 month period from January to May of 2017.

Under Pressure: Ambulatory Blood Pressure Control, Stephen Huelskamp, Md, Juergen Kloo, Md, Christine Giordano, Md, Amit Vira, Md, Albert Lee, Md, John Caruso, Md, Barbara S. Knight, Md

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

Smart AIM: Improve hypertension control with the following goal: Within three months 60% of patients with hypertension will have a blood pressure less than 140/90 during their most recent office visit.

Lost In Translation: A Standardized, Interdepartmental Approach To Improve The Safety Of Inpatient Transitions Of Care, Allison Greco, Md, Andrew Brown, Md, Kristin Lohr, Md, Bracken Babula, Md, Rebecca C. Jaffe, Md

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

AIM:

During the 2016-2017 academic year physician perception of favorability regarding inpatient interunit handoffs will meet the national HSOPS benchmark without negatively impacting patient bed flow.

All ACGME training programs at Thomas Jefferson University Hospital will expose their new trainees to standardized handoff training during orientation in June 2017 as well as adapt a framework for monitoring trainee compliance and proficiency.

Helping To Support Cpc+ Initiative To Integrate Behavioral Health Within Primary Care: A Team-Based Approach To Improving Depression Management, Daniel J. Devine, Md, Jesse Edwards, Md, Sarah E. Rosenberg, Md, Bracken Babula, Md, Jason Ojeda, Md, Lawrence D. Ward, Md, Mph, Facp, Barry S. Ziring, Md

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

AIM:

The objective of this project is to increase the rate of documented successful treatment of depression for both new and established diagnoses of depression at Jefferson Internal Medicine Associates (JIMA) from 29% to 50% over 12 months.

Improving Medication Reconciliation Using Provider Education And An Ehr Hard Stop, Patrick G. Connors, Md, Bracken Babula, Md

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

AIM:

By using a sequence of two distinct interventions, we aim to improve the rate of medication reconciliation at Jefferson Internal Medicine Assoc.

The Use Of Telemetry Monitoring Among General Medicine Patients, Debbie Chen, Md, Gretchen A. Diemer, Md

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

Objective:

To determine why and when general medicine non-ICU patients are upgraded from a non-telemetry level of care to telemetry monitoring at Thomas Jefferson University Hospital (TJUH). Comparison of the reasons for initiation of continuous ECG monitoring with the AHA and ACC guidelines would provide a greater understanding of the applicability of these recommendations to non-ICU general medicine patients. This information can provide guidance to identify areas of intervention to decrease inappropriate and/or overutilization of telemetry. The ultimate goal is to identify general medicine patients who are likely to benefit from continuous ECG monitoring, without negatively affecting clinical outcomes for …

Assessing The Burden Of Unnecessary Central Venous Catheters In Patients On Medical-Surgical Floors, Justine Blum, Md, Christopher Mcgrath, Md, Anita Modi, Md, Shivam Saxena, Md, Ashish Shah, Md, Nimrita Sidhu, Md, David Oxman, Md

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

Project goals:

Our project goals are to:

a) assess the burden of unnecessary PICCs and other non-tunneled central lines on med-surg units at TJUH and

b) understand the underlying reasons behind the problem. In the first phase of our project we conducted an audit of med-surg unit PICCs and other non-tunneled central lines with the goal of obtaining a rough estimate of the number of line days that are unnecessary.

SMART AIM

By December 31, 2017, the TJUH medical-surgical floors will reduce the number of unnecessary PICC lines by 30%.

Analysis Of Clostridium Difficile Patterns At Thomas Jefferson University Hospital, Andrew Tseng, Kulvir Nandra, Md, Kelly Zabriskie, Phyllis Flomenberg, Md, Scott W. Cowan, Md

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

AIMS:

To analyze CDI patterns to TJUH, particularly in Opportunity Units

To visually examine the relationship between CDI cases within units

Provide data analysis to the CDI working group

Tracking And Improving Bedside Procedures Through Standardized Documentation, N. Sich, L. Gartner, J. Sternlieb, K. Noonan

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

Proposal and Goals:

We propose to create a standardized electronic procedure note that will replace all documentation for bedside procedures without sedation.

◦Makes notes legible and easily identified

◦Allows uniform tracking of metrics necessary to identify outcomes from a procedure (blood loss, specimens, post-procedure studies, complications)

2.The procedure note will be created in such a way as to allow specialized procedures to be added over time with minor customization to improve physician/nursing work flows and increase efficiency

◦Allows procedures to be sorted and tracked by type

◦Will be constructed to allow attaching CPT codes to patient charts via documentation

3. …

Filling The Void: A Low Cost, High-Yield Method To Addressing Incidental Findings In Trauma Patients, N. Sich, A. Rogers, D. Bertozzi, P. Sabapathi, L. Gartner, W. Alswealmeen, P. Lim, J. Sternlieb, J. Yuschak, O. Kirton, R. Shadis

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

In this study we:

Report the incidence of incidental findings in a suburban trauma center treating primarily blunt and elderly trauma

Propose simple solutions to increase the rate of disclosure to patients

Limited Post-Operative Narcotic Use In Elective Laparoscopic Cholecystectomy, Prabhu Senthil-Kumar, Md, Tanya Olszewski, Md, Robert Josloff, Md, Kristin Noonan, Md

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

Purpose:

To limit narcotics use

Cochrane review: multiple studies have shown postoperative pain can be managed with non-narcotic meds with good outcome

Less medication related side effects:N/V, constipation, disorientation

Prevents substance addiction/abuse

Perioperative Glycemic Management, A. Rogers, T. Olszewski, N. Sich, K. Noonan

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

Proposals and Goals:

1. We propose creating a standard easy to use and safe protocol for glycemic management for same day/elective surgical patients.

2. Following implementation in same day and elective surgical procedures, we propose expanding the protocol to be effective in urgent and emergent inpatient surgical procedures.