Medicine and Health Sciences Commons^™

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.

Spinal Cord Injury Activation Alert: Revisiting And Revamping Protocols, Ritam Ghosh, Md, Ralph Marino, Md, Michael Wolf, Md, James S. Harrop, Md

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

Objective

Our objective was to look at the current protocol for spinal cord injury activation alerts and to highlight deficiencies in the system. Currently, any physician at Jefferson can call this alert, which often leads to a misuse of resources and wrongful identification of true spinal cord injury.

In order to refine the protocol, we believe that the Cord System should be used for the following guidelines:

1. Identify patients w Spinal Cord Injury (SCI)
2. Identify patients for SCI research trials
3. Identify patients who require surgery

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 …

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 – …

Speed And Safety: Emergency Department Ultrasound Lockboxes For Peripheral Iv’S, M. Trifan, S. Schiff, D. Devlin, B. Warden, M. Magee

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

Objectives

• To decrease the average amount of time needed to place an USGIV by installing lock-boxes with all necessary materials on the ultrasound carts.
• To eliminate a time-consuming step in gathering materials for USGIV, while satisfying safety standards for securing sharps in the department

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.

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

Treatment Summaries For Head And Neck Cancer Survivors: Improving Patient Self Efficacy And Survivorship Care, Michael C. Topf, Md, Jena Patel, Ramez Philips, Md, David Cognetti, Md

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

Objective

• To determine if receiving treatment summaries enhances patient understanding and recall of cancer and treatment details, improves patient self efficacy, and serves as a useful patient tool after completion of head and neck (HNC) therapy

“Can You Send Over The Imaging?” Analyzing The Patient Transfer Process At Tjuh, Walker Lyons, Md, Peter Altshuler, Md, Andrew Hallett, Md, Lindsay Lynch, Md, Tommy O'Malley, Md, Steven Woodward, Md, Alicja Zalewski, Md, Scott Cowan, Md

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

Objective

Our goal was to investigate possible ways to improve the transition of care when patients are transferred to Jefferson Center City. As a quaternary care hospital with a large transfer volume, it is especially important to look for ways to optimize this process because it can improve timely patient care, reduce and eliminate unnecessary studies and diagnostic tests and save time and work that could be better spent in other aspects of treating the patient.

Developing A Neurosurgical Spine Post-Operative Note Template On Epic For Improved Multi-Disciplinary Care, Omaditya Khanna, Md, Geoffrey P. Stricsek, Md, Giuliana Labella, Rn, James Harrop, Md, Jesse Edwards, Md

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

Introduction

The care of neurosurgical spine patients often involves a multi-disciplinary team, including neurosurgery residents, hospitalists, nursing staff, and physical/occupational therapists.

Oftentimes, post-op spine patients are on a non-neurosurgical service (hospitalist, MICU/SICU, medicine), who are provided with scant sign out on the procedure(s) performed.

The treatment team(s) that are helping manage patient care post-operatively are often unaware of the procedure performed, and what are the salient clinical signs/symptoms, radiographic findings, and laboratory values that need to be closely monitored

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.

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.

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.

Small Bowel Obstruction: Facilitating Diagnosis And Optimizing Resuscitation And Management, Robin Naples, Md, Kendrick Law, Md, Quinton Campbell, Md, Ryan Bateman, Md

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

Introduction

As a common surgical emergency that presents in our Emergency Department, Small Bowel Obstruction (SBO) is a disease process where appropriate treatment relies on early detection, fluid resuscitation, and gastric decompression. Despite SBO representing a common emergency, many patients experience inadequate or delayed management as compared to established guidelines, potentially leading to suboptimal treatment and resolution of SBO. As order sets and alerts within Epic are in place for other disease processes whose management relies on timely diagnosis and fluid resuscitation (e.g. sepsis), objectives for our quality improvement plan involve incorporating elements of alerts and order sets within our …

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

Escalation Of Care After Admission Within 24 Hours, Joseph Jean, Md, Mitchell Berman, Md, Christopher Ponce, Md, Kory London, Md

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

Objectives

1. Identify high risk patients in the ED who require hospital admission and may need higher levels of care.
2. Identify patterns or diagnoses in the ED that predispose patient care to escalations after admission.

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. …

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.

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.

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%.

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.

Application Of Alvimopan As A Component Of Enhanced Recovery After Surgery (Eras) Protocol For Patients Undergoing Radical Cystectomy And Diversion (C&D), Thomas Hardacker, Md, Mba, May Jean Counsilman, Md, Benjamin H. Rudnick, Md, Edouard J. Trabulsi, Md, James R. Mark, Md, Leonard G. Gomella, Md, Mark J. Mann, Md, Costas D. Lallas, Md, Scott G. Hubosky, Md

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

Introduction

• Radical cystectomy with urinary diversion (C&D) is performed for patients with muscle-invasive bladder cancer (MIBC) or refractory carcinoma in situ (CIS)
• C&D patients receive one of several types of diversion depending on their age, comorbidities, functional status, and extent of disease (Figure 1)
• Post-operative length of stay (LOS) can be prolonged (9-11 days) and 30 day readmission rates and mortality elevated (30% and 1.5%); return of bowel function usually the rate-limiting step to discharge
• Enhanced Recovery After Surgery (ERAS) protocols utilize pre-, intra-, and postoperative elements in order to improve return of bowel function and decrease LOS
• Alvimopan is …

Expedited Referral To Inpatient Hospice Unit Through The Jefferson Methodist Hospital Emergency Department, Brian Fromm, Md, Kory London, Md, Facep

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

Background

Palliative care is the branch of healthcare that aims to provide symptomatic relief for patients with chronic or incurable medical conditions. Hospice is a subcategory of palliative care in which the focus is placed on comfort to the exclusion of further curative efforts, generally reserved for patients with a life expectancy of six months or less.

The American College of Emergency Physicians (ACEP) Choosing Wisely guidelines recommend that emergency physicians refer appropriate patients to hospice and palliative services. Preventing hospital admission in favor of transfer to an inpatient hospice unit “can benefit select patients resulting in both improved quality …

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 …

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 …

Coaching Operating Room To Pacu Handoff With A Standardized, Multidisciplinary Checklist, Courtney L. Devin, Md, Kathleen Grife, Rn, Ms, Marissa Weber, Md, Richard F. Schmidt, Md, Megan P. Lundgren, Md, Scott W. Cowan, Md

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

Purpose

To pilot a standardized multidisciplinary bedside handoff for any patient admitted to the post-anesthesia care unit (PACU) from the operating room.

Effectiveness Of An Educational And Interdisciplinary Intervention In Reducing Continuous Cardiac Monitoring In An Academic Medical Center, Alexander Smith, Md, Rebecca Loh, Md, Philip Margiotta, Md, Bradford Hilson, Md, Alan Kubey, Md

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

Smart Aim Statement

• Our study aimed to assess the effect of a combined resident-education-and rounding-checklist-protocol intervention on the percentage of patients discharged with active CCM orders on teaching general medicine services.
• We hypothesized that our intervention would reduce the number of patients discharged on CCM (an estimate of overall inappropriate CCM use) by 50% over a 6-8 week period