Medicine and Health Sciences Commons^™

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.

Increasing Effectiveness Of The Surgical Airway Response System: Introduction Of The Otolaryngology Airway Pager, Quality Improvement Project Of The Pgy-2 Class, Erin Reilly, Md, Lauren Galinat, Md, Ryan Rimmer, Md, Gregory Epps, Md, Nikolaus Hjelm, Md

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

Introduction:

The need for an Otolaryngology airway pager is based on several external and internal factors. The current communication pathway for emergent airways at our institution is well established but often misinterpreted. The protocol is outlined in Figure 1. The priority to reach out to other departments is based on their availability of an attending in house overnight. Furthermore, there is often a delay in contacting the Otolaryngology department. Our service has multiple pagers to accommodate for each of our inpatient teams, which can be confusing for other services. One of the driving events for this project was an incident …

Philadelphia Drug Monitoring Program And Compliance With Department Of Health Requirements, Paniz Heidari, Do, William Wieczorek, Md, Jayassree Iyer, Md, Denise Pineda-Fortin, Md, Elizabeth Liveright, Md

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

Objectives:

With this newly instituted mandate, we found that many of the resident did not have access to the PDMP query site. Our initial goal is to have 100% of residents have log-in access to the PDMP site. Our long-term goals involve increasing the query of the PDMP website by OB-GYN residents prior to prescribing narcotic pain medication.

There are several changes that we can make to result in improvement of our initial goal including: identifying residents that require access, working with program coordinator to identify gaps in their PDMP application, and assisting in providing DOH with any additional documentation …

Increasing Ultrasound-Guided Thyroid Biopsy Yield, T. Conor Mckee, Md, Christopher G. Roth, Md, Ms-Hqs

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

Objectives: Conduct Plan-Do-Study-Act (PDSA) performance improvement project to improve thyroid biopsy yield
Short Term>reduce unsuccessful biopsies by 50% Long-Term>eliminate unsuccessful biopsies

Improving Proficiency In Central Venous Catheter Insertion: Standardized Simulation Based Training For Internal Medicine House Staff, John Madara, Md, Christoph Hutchinson, Md, Ma, Frances Mae West, Md, Ms

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

Objectives:

The objectives of this study are to assess residents' pre-workshop ability and comfort with CVC placement, undergo a standardized online didactic and hands-on clinical training simulation workshop, and subsequently undergo a proficiency test using simulation models to assess competency. The goal of a standardized training module is to create a universal approach to CVC placement in our institution and improve comfort and technical ability of house staff. We hypothesize that this will reduce complications and improve patient care and safety.

Quality Review Of Irradiated Cellular Blood Product Orders, Matthew Grzywinski, Vandy Ly, Md

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

Objectives:

Our goal is to educate house staff on the indications for irradiated blood products. We hope to reduce the number of inappropriate irradiation orders to less than 50% of the total orders for irradiated blood products and to be followed up over time.

Addressing Barriers To Breast Cancer Screening: Where To Intervene To Increase Mammogram Completion Rates, Jennifer Laporta, Md, Robert J. Mcclowry, Md, Elizabeth "Mackie" Talley, Md, Lionel Mcintosh, Md, Allison Rague, Md, Claire Thesing, Md, Amy Leshner, Md, Gillian Love, Md, Daniel Sizemore, Md, Patrick Mcmanus, Md

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

Methods:

Study sought to determine if an intervention would aid in increasing mammogram screening rates in the Jefferson Family Medicine Associates practice.

Consolidation Of P2y12 Testing While Maintaining Quality And Turnaround Time, Geetha Jagannathan, Mbbs, Jerald Z. Gong, Md

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

Objective:

To consolidate the test performed at 2 different locations at 1, thereby improving cost effectiveness while maintaining quality and result turnaround time.

Does Physician Education Of Alternative Therapies For Obstructive Sleep Apnea Improve Utilization?, Colin Huntley, Md

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

Methods:

We conducted a retrospective chart review of patients in the Jefferson Sleep Disorder Center (JSDC) consisting of 2 cohorts of patients. The first was a group of patients undergoing PSG in March, 2014 prior to institution of the UAS program. The second was a cohort of patients undergoing PSG in July 2016 after institution of the UAS program, positive initial results, readily available literature in the JSDC, and a physician in-service including details of the procedure and outcome, quality of life, and complication rate data.

We collected demographic and PSG data. We then reviewed the electronic medical record and …

Standardized Consent Forms For Surgical Procedures: An Intervention To Improve The Resident-Led Informed Consent Process, C. Hodge, N. Sich, T. Olszewski, A. Rogers, R. Josloff, K. Noonan

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

Objectives and Goals:

To provide high quality, consistent consent forms for common surgical procedures and improve resident workflow by creating and implementing standardized printed consents for common surgical procedures.

These consents will be used by residents consenting patients in the ED or inpatient setting.

Consents shall include standardized procedure descriptions, risks and benefits of the procedure, and alternative treatment option descriptions, risks and benefits

Use Of Standardized Patient Scenarios To Train Medical Assistants In An Ambulatory Rehabilitation Medicine Clinic, Lawrence Asprec, Md, Ashley Depadua, Md, Sarah Durante, Md, Nicholas Freedman, Do, Andy Olsen, Do, H. Kelly O' Donnell, Do

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

Objectives:

To improve the efficiency of our outpatient Rehabilitation Medicine clinic without sacrificing high value/quality patient care.

To clarify the responsibilities of the MA and identify areas of redundancy in the rooming process.

To demonstrate the utility of in-situ simulation for MA training.

To reduce the time it takes for MAs to complete all assigned tasks to 10 minutes or less per encounter in at least 50% of patient encounters within two months from the time of intervention.

To potentially highlight other areas in which to improve clinic efficiency and overall patient satisfaction (e.g. front desk registration process, resident and …

How Good Are We At Determining Risk? Quantifying The Accuracy Of Clinician Determined Risk For Vte Prophylaxis, Katerina Dukleska, Md, Adam P. Johnson, Md, Mph, Tyler M. Bauer, Myles Dworkin, Johanna Beck, Kamini D. Patel, Rn, Geno J. Merli, Md, Scott W. Cowan, Md

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

Objectives:

Create and validate a simple tool for concurrent audits of risk stratification, compliance and documentation

Evaluate accuracy of clinician risk stratification and prophylatic ordering practice compared with a standardized Caprini RAM across different assigned risk categories

Provide recommendations for EPIC VTE Prophylaxis CDS Development

Improving The Patient Colonoscopy Prep Experience, Natalie Cosgrove, Md, Andrew Dargan, Md, Raja K. Dhanekula, Md, Gloria Francis, Md, Komal Gandhi, Md, Andrew Kistler, Md, Mark Malamood, Md, Bolin Niu, Md, Sheela S. Reddy, Md, Apeksha Shah, Md, Christina Tofani, Md, Andrew Zabolotsky, Md, Robert Cohen, Md, Stephanie M. Moleski, Md, Jorge Prieto, Md

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

AIM:

To improve patient prep compliance, prep quality, and an overall better experience by designing a prep specific website that will address the most common prep questions and concerns

Once launched, the website address will be placed on printed colonoscopy prep instructions and stated on the after hours GI clinic voicemail as an additional patient resource

A Quality Improvement Project To Reduce The Wait Time For Initial Appointment In An Urban Outpatient Sleep Center, Anasua Chakraborty, Md, Ritu G. Grewal, Md

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

Project Aim:

In this study we aimed to see if replacing one face to face follow up visit after sleep study with a phone call by a trained office staff will

-decrease the total number of follow up office visits, thus decreasing health care cost

-increase the number of new patients seen during the 6 month follow up period

-Did not decrease patient compliance.

Risk Factor Analysis For 30-Day Readmission Rates Of Newly Tracheostomized Children, Jenna Briddel, Md, Abigail Strang, Md, Jessica Levi, Md, Patrick Barth, Md, Aaron Chidekel, Md, Udayan Shah, Md

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

Objectives:

Pediatric patients undergo tracheostomy for a variety of reasons; however, medical complexity is common among these patients. Although tracheostomy may help to facilitate discharge, these patients may be at increased risk for hospital readmission. The purpose of this study was to evaluate our institutional rate of 30-day readmission for patients discharged with new tracheostomies and to identify risk factors associated with readmission.

Study Design:

A retrospective cohort study was conducted for all pediatric patients ages 0-18 years with new tracheostomies at our institution over a 36-month period.

Methods:

A chart review was performed for all newly tracheostomizedchildren from 2013 …

A Video-Based Educational Intervention For Providers Regarding Colorectal Cancer Screening, Zoe Agoos, Md, Bryan Botti, Md, Laura Emerson, Md, Angela Silverman, Md, Mph, Lori Atkinson, Md, Danielle Dang, Md, Mph, Elizabeth Collins, Md, Erica Li, Md, Rebecca Simon, Md, Michael Weissberger, Md, Geoffrey Mills, Md, Phd

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

Methods:

Email sent to providers asking them to complete a 7 question survey regarding knowledge and self-reported comfort in screening for colorectal cancer using a shared decision-making approach.

Shedding Light On The Off-Hours Coverage Gap In Radiology: Improving Turnaround Times And Critical Results Reporting, Gilda Boroumand, Md, Jaydev K. Dave, Phd, Ms, Christopher G. Roth, Md, Ms-Hqs

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

Objective:

Devise a plan to optimize off-hours faculty and trainee staffing within the Department of Radiology

Measure the magnitude of patient safety gains in terms of report turnaround times (TAT) and critical results communication times (CRC)

Beat To Beat: Implementing A Tailored Literature Review E-Newsletter For A Multidisciplinary Subspecialty Group, Shashank Behere, Md, Steven Ritz, Md

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

Objective:

To increase availability and exposure to recent, relevant, reliable literature from a range of sources, for a multidisciplinary cardiac center, by creating an e-newsletter summarizing articles of interest.