Medicine and Health Sciences Commons^™

The Tjuh Hospital Medicine Covid19 Emergency Taskforce: A Guiding Light During The Surge Of Spring 2020, Rebecca Jaffe, Md, Alan Kubey, Md, Gretchen Diemer, Md, Michele Decastro, Lily Ackermann, Md, Christopher Haines, Md, Jesse Edwards, Md, René Daniel, Catriona Harrop, Md, Jonathan Woo, Md, Jack Stewart, Md

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

In mid March 2020 a highly infectious and deadly disease appeared in Philadelphia that no American physician had ever treated before. The challenge of disseminating reliable and relevant information about a novel and dangerous pathogen across practice areas cannot be understated.

Usual practices for communication and leadership are not designed to manage this kind of challenge.

Qr-Code Based Just-In-Time Platform For Perioperative Covid Guidelines, David F. Nelson, Md, Mba, Anna L. Rabinowitz, Md

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

When the COVID-19 Pandemic arrived in Philadelphia in March 2020, leadership at Thomas Jefferson University Hospital began a process of quickly authoring and updating a multitude of clinical guidelines, PPE (personal protective equipment) usage protocols, and surgical care standards in rapid succession.

The scope and scale of perioperative care at TJUH, which is made up of the Departments of Anesthesiology, Surgery, and Perioperative Nursing, means that a large and diverse number of individuals need timely access to a curated collection of resources that are specifically relevant to emergency airway management, urgent surgical care, testing, and recovery.

Large …

Home Telemonitoring Of Covid Patients By Medical Students At The Christiana Care Virtual Practice, Thomas Marconi, Jr, Chelsea Richards

Health Equity and Quality Improvement (HEQI) Summit

SARS-Cov2 arrived in Delaware on March 11, 2020. By March 22, 2020, stay at home orders were in place1. During this time, CareVio, a subsidiary of ChristianaCare, was tasked with developing a strategy to monitor the Delaware community. CareVio repurposed Twistle – a telemonitoring application utilized to distribute symptom related surveys and conduct text message conversations for follow up. This service had the capability to act as a virtual information desk and triage patients to be seen by virtual practice providers or the emergency department. Patient monitoring via Twistle was initiated on March 18, 2020 and medical students from Sidney …

Maintaining Powered Air-Purifying Respirator (Papr) Supply Through Repair Of Damaged Hose Units By 3d Printing, Dante Varotsis, Robert Ries, Michelle Ho, Kathryn Linder, Jordan Kurzum, Robert Pugliese, Pharmd, Bon Ku, Md, Mpp, Matt Fields, Md, Morgan Hutchinson, Md

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

• Powered air-purifying respirators (PAPRs) are a type of Personal Protective Equipment (PPE) that serves an essential line of defense against the spread of COVID-19 and other airborne pathogens.
• Demand for PAPRs are at a premium during a time where supply chains have been disrupted.
• The hose component of the 3M™ Air-Mate™ PAPR has a fragile interface with the hood, leading to damage and rendering the PAPR unit unsafe for continued use.
• PAPR units are on backorder, as are their components.
• Given the acute need for functional PAPRs other approaches for repair were explored.

Initiatives In Anesthesia Workspace Hygiene During Covid-19: The Gray Airway Basin And The Epic Hand Hygiene Event, Anna Rabinowitz, Kent Berg, Daniel Casey, Dietrich Gravenstein

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

The COVID-19 Pandemic has highlighted the need for anesthesia providers to decrease workspace contamination, particularly during and after airway management.

Delineation of “clean” and “dirty” spaces in the anesthesia workplace has been historically challenging, but the heightened awareness of microbial contamination presents a new opportunity to effect behavioral change among staff.

Irradiation Of N95 Masks For Their Sterilization And Reuse During The Covid19 Pandemic, Tara Tyson, Phd, Alex Kubli, Ms, Matthew Mistro, Ms, Karen Mooney, Phd, Amy Harrison, Phd, Adam Dicker, Md, Phd

Health Equity and Quality Improvement (HEQI) Summit

Research Objective

We sought to investigate the feasibility of irradiation for N95 mask sterilization.

A Strategy For Deploying Large-Scale Volunteer Continuous Bag Valve Tube (Bvt) Ventilation, Robert Ries, Erin Jennings, Michael Velez, Caroline Komlo, Morgan Hutchinson, Md, Robert Pugliese, Pharmd, Bon Ku, Md, Mpp, Matt Fields, Md

Health Equity and Quality Improvement (HEQI) Summit

Part 1: Hospital Guide

The hospital guide outlines steps and considerations for the healthcare system to successfully implement a manual ventilation strategy

Part 2: Online BVT Training Module

We created an online articulate evidence based training module for safe and effective Bag-Valve-Tube (BVT) ventilation for medical and nonmedical providers.

Anesthesiologist-Led Covid-19 Airway Training Skills Session To Teach Novel Team Approach And Workflow, Anna Rabinowitz, Daniel Casey, Elaine Kilmartin

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

Intubation is an aerosol-generating procedure that poses a significant infectious risk to the operator in the COVID-19 era, where the volume of intubations was expected to increase dramatically. Following national anesthesia societal and organizational recommendations regarding best practices to decrease risk of viral transmission, a new 3-person airway team approach was developed. Additions to the preexisting airway management workflow included an aerosol-containing intubation shield, a new breathing circuit configuration incorporating HEPA filtration, and the use of unfamiliar PPE, all of which required mastery of a complex sequence of events surrounding the patient encounter. This high-stakes workflow was …

Nursing And Provider Safety Checklist For Covid-19 Patients, Michele Decastro, Msn, Crnp, Jennifer Zak, Bs, Rn, Pccn, Andrew Thum, Msn, Ml, Rn-Cc, Ccctm, Kristine Meagher, Rn, Msn, Acns-Bc

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

As increasing numbers of Covid-19 patients were admitted to the hospital, multiple Med-Surg and Telemetry units were needed to provide care. All healthcare providers noted difficulty in communicating patient plans of care across multiple units and multiple teams. Providers, Clinical Nurses, and Nursing leadership all noted differences in processes for care and communication among units and teams.

Expansion And Conversion Of Family Medicine And Neurohospitalist Services Into Covid-19 Services, Zachary Klock, Md, Aimee Mcmullin, Md, Jesse Edwards, Md, Christopher Haines, Md

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

• During the COVID-19 pandemic, there was an anticipated increase in the number of patients admitted with COVID-19.
• To meet the increased number of admitted patients, additional providers and teams were needed to care for hospitalized patients during the pandemic.
• Pre-existing teams needed to find ways to expand (in the case of the Family Medicine service) and repurpose (in the case of the Neurohospitalist service) in order to care for an increased number of patients.

Covid: Decoded - A Website, Blog, And Social Media Page With Resources And Information For The Public, Jessica Smith, Taylor Jones, Madeline Norris, Benjamin Meyers, Christopher Haines, Md

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

Information about COVID19 in the news and on social media platforms is overwhelming, confusing, riddled with jargon and sometimes straight up wrong. Makig it easy for the public to misinterpret facts or simply accept headlines and infographics at facevalue without checking with primary and/or reputable sources.

The nature of social media also allows for a perpetuation of this misinformation without recourse. Recall the one article floating around Facebook reporting that gargling salt/vinegar water could help prevent COVID19. We needede a source of simplified, reliable information about the pandemic for people outside of the health professions.

Medical students …

Development And Implementation Of A Covid-19 Specific Peri-Operative Workflow For Anesthesia Providers, Alexander Olson, David Maguire, David Gratch, Dietrich Gravenstein, Michael Mahla, Anna Rabinowitz

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

• Needed to develop and clarify the use of PPE in the COVID-19 era
• New considerations for infection control in OR
• Unique airway equipment and filter placement considerations
• Potential shortages of equipment and medications, need for conservation
• Need to incorporate human factors principles into protocol release and procedural compliance

We realized that there was no standard protocol for these functions existing in a visually compelling graphic form for wide distribution throughout anesthesia care areas, and sought to create one.

Avoid, Delay, Shorten. Results Of Radiation Oncology’S Covid19 Patient Exposure Risk Mitigation Guidelines, Alex Kubli, Ms, Lilya Babinski, Bs, Angelia Landers, Phd, Christian Fernandez, Md, Amy Harrison, Phd

Health Equity and Quality Improvement (HEQI) Summit

We implemented evidence-based COVID19 guidelines on 3/16/20 to minimize patient exposure risks by avoiding, delaying, and shortening patient treatments when possible.

We analyzed the effectiveness of our COVID guidelines by comparing the number of new patient starts and number of treatments before and after implementation.

Our department successfully decreased patient exposure risk by reducing new prescription starts, rates of longer treatment courses, and overall number of treatment encounters in an evidence-based approach.

Sars-Cov-2 Testing Guidelines For Patients Admitted To Mrh For Inpatient Rehabilitation, Deborah Cassidy, Do, Roger Liu, Do, Malav Shah, Md, Kyle Hummerston, Do, Jeanne Doherty, Md

Health Equity and Quality Improvement (HEQI) Summit

We implemented a clinical algorithmic approach with an emphasis on symptoms and risk to stratify patients into 3 groups:

• Acutely Ill COVID Rule Out/PUI
• Stable COVID Rule Out/PUI
• COVID OBS

Incidental Findings On Ldct For Lung Cancer Screening: Prevalence And Clinical Management, Chris Mcgrath, Md, Mrinalini Venkata-Subramani, Md, Brandon Menachem, Md, Amry Majeed, Brooke Ruane, Crnp, Christine Shusted, Mph, Julie Barta, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• To define the frequency of incidental findings on low-dose CT (LDCT) scans among patients undergoing lung cancer screening.
• To determine the current reporting methods for incidental findings and measure the frequency of clinical follow-up.

Scanning For Qi: Outcomes From A Resident And Sonographer Driven Improvement Of Radiology Resident Ultrasound Technique, Brian Blumhof, Md, Corinne Wessner, Bs, Rdms, Rvt, Kristen Mcclure, Md

Health Equity and Quality Improvement (HEQI) Summit

Objective

The aim of this structural quality improvement (QI) project was to improve the educational ultrasound curriculum.

We created the pilot for an enduring addition to the radiology residency at Jefferson, with plans to include additional ultrasound examinations as the curriculum becomes more robust.

Stakeholders included not only the radiology residency, which would benefit from improved resident education and knowledge, but also the hospital and ultimately patients, who stand to benefit from improved delivery of care.

Improving Accuracy And Ease In The Evaluation Of Adrenal Insufficiency: A Provider-Driven Order Set Aimed At Streamlining Acth-Stimulation Testing, Kimberly Lessard, Do, Luis Arezeno, Md, Eric Shiffrin, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

It is the purpose of our quality improvement project to assist in identification of patients in whom testing for AI may be most appropriate and to address barriers to performing testing correctly via an inpatient ACTH-stimulation order set.

Improving Primary Prevention Of Coronary Artery Disease In Women Using Breast Arterial Calcifications Seen On Screening Mammography, Rachel Redfield, Md, Sarah Kamel, Md, Rani Rajaram, Md, Kathryn Anderson, Ba, Matthew Metzinger, Mba, Kamini Patel, Bsn, Lydia Liao, Md, Katherine Sherif, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Study Aims

• To create an interdisciplinary task force focused on identifying women with CVD by reporting presence of BAC on screening mammograms.
• To monitor the clinical impact of reporting BAC.

Patient Notification Of Incidental Findings On Emergency Department Imaging, Tareva Warrick-Stone, Do, Kim Groen, Do, Mph, Jake Finkle, Do, Sarah Lurvey, Do, Fred Gmora, Do

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Ultimately, the goal of properly handling incidental findings in the ED is to preserve the long-term health of the patient and reduce malpractice risk. The objective of this project is to improve the quality of attending, resident, and APP practice in communicating incidental findings noted on radiology-reviewed imaging (X-ray, US, CT, MRI) in the ED. This will be achieved by establishing a methodological approach to informing patients, accurately documenting, and providing clear discharge instructions for follow-up. This project will not include bedside imaging or wet-read discrepancies and will not include other incidental findings such as lab or …

A Novel 3d Model To Learn Coronary Angiography, N. Haroian, S. Chandragiri, M. Ho, M. Fields, D. Fischman, M. Savage, N. Ruggiero, A. Vishnevsky

Health Equity and Quality Improvement (HEQI) Summit

The limitations of 2D imaging creates challenges for cardiology fellows learning the basics of coronary angiography.

Using a 3D model to simulate a coronary angiogram outside the cath lab could shorten the learning cure and improve understanding of this essential procedure.

Using A Resident-Led Process Improvement Committee To Change Pain Medication Prescribing Habits: Early Results, Christina Jacovides, Md, R. Zheng, Md, Brian Till, Md, Walker Lyons, Md, Nkosi Alvarez, Md, Zachary Callahan, Md, Keyur Patel, Md, Micaela L. Collins, Md, Mph, James Lee, Md, Mph, John Kairys, Md

Health Equity and Quality Improvement (HEQI) Summit

The aims of this project were to:

1. Streamline the ordering of IV and PO pain meds
2. Encourage the appropriate ordering of Ofirmev®

Jefferson Postpartum Oxytocin Protocol Standardization, Julie Gomez, Ms, Farnaz Farhi, Md, Sara Hinton, Pharmd, Tara Biedrzycki, Pharmd, Deborah Cruz, Msn, Crnp, Jason Baxter, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

We aimed to reduce the variation and subsequent waste of postpartum oxytocin by standardizing the concentration available across the three maternity hospitals within the hospital enterprise system.

Improving Accuracy Of Admission Medication Reconciliations For Newly Admitted Patients To Resident Hospital Medicine Teams, Eric Gold, Md, Amit Agarwal, Md, Zeba Hussaini, Md, Mario Fonseca-Paricio, Md, Ilya Danelich, Pharmd, Rph, Adam Binder, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

For patients admitted between August 2020 and February 2021 to a general medicine service, we will reduce the number of home medication list inaccuracies by 25% within 48 hours of admission in order to improve transitions of care upon discharge.

Improving Adherence With Amiodarone Complications Screening Guidelines Using A Clinical Epic Tool, Wajahat Humayun, Md, Alec Vishnevsky, Md

Health Equity and Quality Improvement (HEQI) Summit

The purpose of this study was to determine baseline adherence to amiodarone screening guidelines and t.

The Impact Of Provider Accessibility And Usability Of Antibiotic Stewardship Guidelines, Hillary Landon, Md, David Katzianer, Md, Michelle Hannon, Md, Katherine Duffey, Md, Bryan Hess, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• We worked with the antimicrobial stewardship team on the rollout of a new digital platform encompassing antibiotic prescribing guidelines and institutional antibiograms with userfriendly features such as mobile accessibility and clear selection menus.
• Our goal was to increase provider awareness and use of institutional guidelines by at least 25% with the ultimate hope of improving antimicrobial stewardship (measured by frequency of broad-spectrum antibiotic ordering) for the hospital within the calendar year.

The Anti-Epileptic Dilemma – A How To For Transitioning Patients On Seizure Medications To Hospice, Erin Kelly, Do, John Liantonio, Md, Mba, Hdmc, Debra Vermette, Md

Health Equity and Quality Improvement (HEQI) Summit

Objective

We propose an approach to antiepiletics in hospice that includes the evaluation of steroids, medication options, pharmacy consultation and seizure breakthrough plan so that we meet the goals of the patient on hospice.

To Anticoagulate Or Not: Decision Making Surrounding Anticoagulation In Patients In Hospice And Palliative Care Programs, Erin Kelly, Do, John Liantonio, Md, Mba, Hdmc, Debra Vermette, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Describe the current guidelines for CAT treatment. - Assess risk factors for bleeding and thrombosis in cancer patients and risk/benefits of anticoagulation.
• Recognize the need for individualized anticoagulation plans in order to make informed decisions that may differ from the guidelines.
• Propose anticoagulation in hospice if it will achieve the goals of the patient.

Implementation Of A Volunteer-Based Hospital Visitation Program For Older Adults, Jennifer Kim, Kristine Swartz, Md

Health Equity and Quality Improvement (HEQI) Summit

This research suggests that a volunteer program has a positive impact on hospital delirium, with longer visits having more effect.

Standardized Bronchoscopy Testing For Immunocompromised Patients, C. Nieweld, A. Gandler, K. Biblowitz, B. Menachem, J. Most

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Determine the consistency in which the order set was followed
• Determine the length of time from finding pulmonary infiltrate to consultation
• Determine the length of time from consultation to bronchoscopy
• Determine whether a follow up note was written by pulmonary
• Determine whether management is affected based on obtained results

Increasing Utilization Of Telehealth In Outpatient Primary Care, Allison Samuel, Md, Candace Derenge, Md, Anahita Molayi, Md, Amanda Kahn, Md, Jason Ojeda, Md

Health Equity and Quality Improvement (HEQI) Summit

Based on survey data, residents are interested in gaining exposure to Telehealth and attendings would like to increase their number of Telehealth appointments. Providers expressed uncertainty about insurance coverage as a major barrier to increasing Telehealth utilization.

SMART AIM: Increase the total number of Telehealth visits at JIMA by 25% and initiate Telehealth visits for residents by May 1st.