Medicine and Health Sciences Commons^™

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 ‘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 …

It Takes A Village: Developing An Airway Management Bundle To Standardize Emergent Intubation Processes In The Emergency Department, James Sacca, Md, Daniel Casey Kim, Md, Dimitri Papanagnou, Md, Mph, Edd(C)

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

Problem Definition

Airway management is at the core of emergent patient care. Emergent intubations in the Emergency Department (ED) at Thomas Jefferson University Hospital (TJUH) have been noted by staff to be variable and not standardized. Staff have also described that equipment tends to be difficult to locate during intubations.

There is no objective data to confirm these claims. Furthermore, there is no bundle in place to guide emergent intubations in the ED.

Our team sought immediate actions to improve ED airway processes.

Improving Ed Door To Puncture Times For Endovascular Thrombectomy In Acute Ischemic Stroke, Richard F. Schmidt, Md, Nabeel Herial, Md, Robin D'Ambrosio, Bsn, Erin Simko, Bsn, Fred Rincon, Md, Maria Aini, Md, Pascal Jabbour, Md, Stavropoula Tjoumakaris, Md, M. Reid Gooch, Md, Robert H. Rosenwasswer, Md, Robin Dharia, Md

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

Objectives

• Optimize the management of patients presenting to TJUH with AIS who are candidates for ET.
• Enable continued process improvement through improved data collection methods and identification of new process metrics.

Initial Response To The Opioid Crisis: Availability Of Buprenorphine And Warm Handoff In The Ed, Lauren Selame, Md, Benjamin H. Slovis, Md, Ma, Theodore Christopher, Md, Facep, Kory S. London, Md

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

Background:

• The United States is in the midst of an opioid crisis.
• The Centers for Disease Control and Prevention has cited Emergency Departments (ED) as important centers for treatment and referral, including medication assisted treatment (MAT), which has been shown to be superior to motivational interviewing and referral alone.1,2
• While direct linkage to outpatient programs via the ED may be an opportunity to better serve this population, data on such “warm handoff” interventions are sparse.

Objective: We initiated an ED opioid use disorder (OUD) pathway, which aimed to initiate buprenorphine therapy and perform warm handoff directly into the community for …

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

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 …

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.

Acute Pancreatitis In The Emergency Department, Gregory J. Lopez, Bs, Matt Hall, Md, Matthew Babineau, Md, Darshan Kothari, Md, Ryan C. Burke, Phd, Mph, Richard E. Wolfe, Md, Sunil G. Sheth, Md, Stephen Freedman, Md, Nathan I. Shapiro, Md, Carrie Tibbles, Md

Phase 1

Introduction: Acute pancreatitis (AP) is a common emergency department (ED) presentation with a variety of outcomes. Stratifying AP severity with scoring systems can allow physicians to effectively manage patient disposition.

Objective: To identify ED pancreatitis patients who will likely be admitted to the ICU or be discharged within 48 hours, and to validate existing pancreatitis severity scores.

Methods: Patients with a final ED diagnosis of AP and/or lipase ≥ 3 times the upper limit of normal were enrolled in a prospective, observational chart review study. Parametric and non-parametric descriptive statistics were used to describe the patient population. Area under receiver …

Emergency Medicine Palliative Care Access (Empalla): Protocol For A Multicentre Randomised Controlled Trial Comparing The Effectiveness Of Specialty Outpatient Versus Nurse-Led Telephonic Palliative Care Of Older Adults With Advanced Illness, Corita R. Grudzen, Deborah J. Shim, Abigail M. Schmucker, Jeanne Cho, Keith S. Goldfeld

Student Papers, Posters & Projects

Introduction Emergency department (ED)-initiated palliative care has been shown to improve patient-centred outcomes in older adults with serious, life-limiting illnesses. However, the optimal modality for providing such interventions is unknown. This study aims to compare nurse-led telephonic case management to specialty outpatient palliative care for older adults with serious, life-limiting illness on: (1) quality of life in patients; (2) healthcare utilisation; (3) loneliness and symptom burden and (4) caregiver strain, caregiver quality of life and bereavement.

Methods and analysis This is a protocol for a pragmatic, multicentre, parallel, two-arm randomised controlled trial in ED patients comparing two established models of …