Medicine and Health Sciences Commons^™

Evaluating The Reliability Of The Problem List For Comorbidity, Joseph W. Schaefer, Alan A. Kubey, Md, Michael Li, Phd, Novel Covid Learning Group

Health Equity and Quality Improvement (HEQI) Summit

The problem list in EPIC provides a centralized source of patient medical conditions that informs medical decision making. This is especially important for COVID- 19 patients where risk scores such as the “4C score” inform care.

The goal of this study was to identify the accuracy of the problem list and identify areas for future improvement.

Improving Serial Imaging Protocols In Spontaneous Intracerebral Hemorrhage, Kevin Hines, Md, Nikolaos Mouchtouris, Md, Fadi Al-Saiegh, Md, Karim Hafazalla, Jacob Mazza, Giuliana Labella, Muhammad K. Athar, Md, Adam Flanders, Md, M. Reid Gooch, Md, Stavropoula Tjoumakaris, Md, Robert H. Rosenwasswer, Md, Pascal Jabbour, Md

Health Equity and Quality Improvement (HEQI) Summit

There is no universally agreed upon protocol to image patient presenting with intra-parenchymal hemorrhage of non-traumatic etiology (sICH). At our institution, it is common practice for a patient to have 3 CT’s done within 24 hours. They are often at onset of symptoms or presentation, 6 hours post onset of symptoms, and finally 24 hours post bleed onset.

The goal of this project will be to assess the safety and efficacy of obtaining this repeat imaging in our patients in the hopes that limiting unnecessary CT head studies will decrease resource utilization, decrease patient radiation, expedite movement of stable patients …

Evaluating Advance Care Planning In Patients With Amyotrophic Lateral Sclerosis: A Retrospective Chart Review, Zachary Klock, Md, Stephanie Dobak, Rd, Gail Houseman, Rn, Margaret Kreher, Md, Facp

Health Equity and Quality Improvement (HEQI) Summit

• ALS is a progressive, degenerative neurologic disorder with inevitable decline in function and ultimately death.
• Most patients and families will be faced with decisions regarding mechanical ventilation and artificial nutrition.
• Prior studies have showed low rates of ACP completion in this population (<50%) and high rates of opt out in programs to aid ACP (nearly 40%).
• By reviewing charts of patients with ALS, we can analyze the impact of ACP on care utilization including artificial nutrition, mechanical ventilation and hospice utilization to help to guide efforts regarding ACP in the outpatient setting.

Addressing The Limitations Of Neurosurgical Care Via Telemedicine, Nikolaos Mouchtouris, Md, Robert Sergott, Md, Mark Moster, Md, Michael Karsy, Md, Laura Sweeney, Crnp, Christopher Farrell, Md, James Evans, Md

Health Equity and Quality Improvement (HEQI) Summit

Novel telemedicine software successfully automates cranial nerve assessment of patients from the comfort of their home

Alteplase Administration For Acute Ischemic Stroke (Ais) In Er - A 5-Year Review, Ali A. Saherwala, Md, Diana Tzeng, Md, Robin Dharia, Md

Health Equity and Quality Improvement (HEQI) Summit

• ER visits for AIS grown in last 10 years by 25%
• Ongoing effort by AHA/ASA to improve access to care with early stroke recognition and awareness
• Time is brain; rate of thrombolysis with alteplase (ALT) should increase with better EMS systems, awareness, and education

Increasing The Rate Of Excisional Lymph Node Biopsies At Easily Accessible Sites When Ruling Out Lymphoma, Catherine M. Tucker, Md, Xiangyun Ye, Christopher Gardner, Austin Redilla, Guldeep K. Uppal, Md, Adam F. Binder, Md

Health Equity and Quality Improvement (HEQI) Summit

The aim of this study is to increase the rate of excisional lymph node biopsies from 78% to 95% in patients presenting to the Center City campus with lymphadenopathy at easily accessible sites by September 2021.

Provider Use Of Risk Stratification Tools For Pe And Cta Ordering Practices, Christy Johnson, Do, Daniel I. Shpigel, Md, Nicole Caltabiano, Do, Benjamin Slovis, Md, Ma, Facep

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Quantify utilization of clinical decision tools, D-dimer and CTA-PE at TJUH and compare to benchmark and implement the logic seen in the adjacent QR code to an EPIC pop-up

The “Ok” Guideline: Implementing An Electronic Electrolyte Repletion Guideline For Improving Rates Of Oral Potassium And Magnesium Delivery, Joshua M. Riley, Jeffrey M. Riggio, Md, Alan A. Kubey, Md

Health Equity and Quality Improvement (HEQI) Summit

Nearly 500,000 doses of potassium (K) and magnesium (Mg) are given at Thomas Jefferson University Hospital (TJUH) each year. More than 80% of these doses are given intravenously.

Guidelines that encourage both intravenous and oral (PO) repletion options increase rates of PO dosing and more successfully attain goal levels than standard care.

Our goal was to increase the percent of K and Mg doses delivered by oral route to >50% of total doses distributed at TJUH within one year of implementation of an Epic-based electronic order set.

Quality Of Post-Discharge Follow-Up In Patients Admitted To Tjuh With Intermediate High Risk Pulmonary Embolism, D. Kramer, P. Kirupaharan, M. Flamenbaum, M. Scharf

Health Equity and Quality Improvement (HEQI) Summit

• Our institution has developed a multidisciplinary pulmonary embolism response team (PERT) to help in the management of patients with intermediate high risk pulmonary embolism
• While the PERT focus is on acute inpatient management, it is important that PERT patients have close follow-up to monitor for known future complications including thromboembolic pulmonary hypertension (CTEPH) and chronic pulmonary embolism syndrome
• CTEPH, in particular, is a potentially treatable disease with significant morbidity if left untreated
• Therefore, an underappreciated and important aspect of the PERT team should be the coordinated follow-up and long term care of these patients
• We wanted to better understand how …

Increasing Depression Screening And Treatment, Emma De Louw, Md, Michael Danielewicz, Md, Michael Haines, Md, Molly Allanoff, Md, Elizabeth Clark, Md, Michael Bozzi, Md, Natalie Antosh, Md, Catherine Guariglia, Md, Yael Horvath, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Increase response to depression advisory in EHR from 39% (January 2021) to 60% or greater (March 2021)
• Increase referrals to behavioral health from baseline of 39/month (January 2021) by 25% (March 2021)

Improving Understanding Of And Compliance With Anti-Shivering Protocols During Therapeutic Hypothermia With Just-In-Time Training, Brittany Heckel, Md, Eunice Lee, Md, Courtney Curran, Md, Kasun Navarathna, Md, Henry Lee, Md, Lucy Maguire, Md, Phd, Malissa Pynes, Md, Shyam Majmundar, Md, Alexander Buslov, Md, Syed Shah, Md, Mba, Matthew Vibbert, Md

Health Equity and Quality Improvement (HEQI) Summit

• Therapeutic hypothermia after cardiac arrest has been demonstrated to improve neurologic outcomes and survival rates following cardiac arrest.
• Shivering during hypothermia increases metabolic demand, increases oxygen consumption and increases difficulty maintaining desired temperatures.
• Gaps in knowledge can lead to inadequate management of shivering, leading

Aims for Improvement

To improve understanding of and compliance with anti-shivering protocols during therapeutic hypothermia post-cardiac arrest.

Postoperative Aspiration Pneumonia (Popna) Prevention Protocol, R. Lamm, Md, D. Pace, Md, B. Till, Md, B. Creisher, J. Curran, E. Foecke Munden, J. Williamson, Iii, S. Cowan, Md, C. Costanzo, Md, Harish Lavu, Md

Health Equity and Quality Improvement (HEQI) Summit

• Postoperative pneumonia increases morbidity, mortality, length of stay, and hospital costs up to $12,000-$40,000 per patient
• TJUH Center City ranked in the top 3rd - 4th quartile of pulmonary complications on the 2020 National Surgical Quality Improvement Program perioperative review
• ICOUGH protocol: widely accepted, standardized set of post-operative interventions to reduce pneumonia incidence
• Survey design: measure ICOUGH compliance before and after implementation of resident note checklist in EPIC

Improving Advanced Care Planning Discussion And Documentation, Justin Robbins, Md, Bharaniabirami Rajaram, Md, Patrick Kukulich, Md, Danielle Verghese, Md, Dianna Cheney-Peters, Md

Health Equity and Quality Improvement (HEQI) Summit

Our goal is to improve ACP discussion and documentation in patients above the age of 65 in our Jefferson Hospital Ambulatory Practice (JHAP) resident clinic. By instituting procedural changes within the EMR and the clinic, as well as improving provider education, we hope that residents can carry out a comprehensive and streamlined discussion regarding advanced care planning. We will institute these changes over the next 3 months, and we predict that there will be an increase in ACP discussion and uploading of appropriate documentation to 50% and 25%, respectively.

Improving Colon Cancer Screening Rates In An Ambulatory Resident Clinic, Ashima Oza, Md, Tina Boortalary, Md, Elizabeth Chin, Md, Tudor Sturzoiu, Md, John Wallis, Md, Sonia Bharel, Md

Health Equity and Quality Improvement (HEQI) Summit

In the US, colorectal cancer (CRC) is the third leading cause of cancer-related deaths. According to the 2018 CDC Behavioral Risk Factor Surveillance System survey, 68.8% of US adults between 50 and 75 were up to date on colorectal screening (CRCS) across all screening modalities. In light of the COVID-19 pandemic, screening has dropped even further and is still 50% below pre-pandemic levels. At Jefferson, our CRCS rate is below the national average at 55.4%. Given the importance of regular screening for CRC prevention, this is clearly inadequate. There are several barriers to completing an invasive screening modality like a …

A Safety Assessment Of The Re-Opening Of An Academic Medical Center Outpatient Endoscopy Unit During The Covid-19 Pandemic, Scott Manski, Christopher Schmoyer, Alice Pang, Richard Denicola, Amy Javia, Melissa Vitolo, Linda Yan, Christopher Cao, Brianna Shinn, Divya Chalikonda, Giselle Mahoro, Ritu Nahar, Joshua Lieberman, Micaela Gernhardt, Neveda Murugesan, Alexandra Leto, Ryan Erwin, Taylor Kavanagh, Stephanie Moleski, Robert Coben, Mitchell Conn

Health Equity and Quality Improvement (HEQI) Summit

• This study aimed to assess outcomes and satisfaction among patients undergoing outpatient endoscopic procedures during the COVID-19 pandemic
• Identifying the rates of COVID-19 symptom development and post procedure testing would provide critical information on patient safety
• Assessment of patient experiences would serve as a guide for potential areas of improvement
• We predicted that with proper protocols in place, outpatient endoscopy was a safe and positive experience

Improving The Virtual Neurosurgery Residency Interview Experience, Ellina Hattar, Md, Omaditya Khanna, Md, Ritam Ghosh, Md, Nikolaos Mouchtouris, Md, Kevin Hines, Md, Daniel Franco, Md, Michelle Hoffman, James S. Harrop, Md, Ashwini D. Sharan, Md

Health Equity and Quality Improvement (HEQI) Summit

The residency selection process has proven a challenge in the face of the Covid-19 pandemic. In the neurosurgery match, residents are chosen based on objective metrics as well as their ability to effectively work as part of a team tasked with caring for medically complex patients faced with neurosurgical conditions. As there remain limitations on the number of externships students could participate in and the Step 1 examination is expected to be reported as either pass or fail in years to come, we will have fewer objective metrics to review in the student application. We conducted a study to best …

Introduction Of Gi Wellness Committee To Reduce Gi Fellow Burnout And Improve Wellness., Richard P. Denicola, Md, Melissa A. Vitolo, Md, Ritu Nahar, Md, Jorge Prieto, Md, Stephanie Moleski, Md

Health Equity and Quality Improvement (HEQI) Summit

Gastroenterology (GI) fellowship is an arduous process which predisposes fellows to fatigue and burnout.

Our baseline survey showed a large number of our fellows to be in danger of burnout.

Aims for Improvement

• To improve the overall wellness of GI fellows, identify stressors and reduce incidence of burnout.
• The goal for the first 6 months of operation is to demonstrate improvement in Mini ReZ survey scores by 25% at starting from Sept 1st, 2020.

Improving Follow Up Compliance For Patients With Sleep Disordered Breathing At Jefferson Sleep Center, E. Fares, Md, A. Ananth, Md, Z. Fast, Md

Health Equity and Quality Improvement (HEQI) Summit

Despite the high effectiveness of CPAP therapy, patient adherence remains variable and a hurdle towards appropriate treatment of their sleep-disordered breathing.

Patients often stop using their CPAP and are then lost to follow-up, which increases their risk of previously mentioned complications that are associated with OSA.

Goals for Improvement

To increase the follow-up rate for patients with OSA.

Improving Sensitivity To And Inclusivity Of Lgbt Older Adults In An Urban Geriatric Practice, Elizabeth Spina, Do, Brooke Salzman, Md, Michael Danielewicz, Md, David Grifith, John Liantonio, Md, Mba, Hmdc

Health Equity and Quality Improvement (HEQI) Summit

CHA’s overall goal is to improve the care delivered to LGBT older adults.

Step 1: Needs assessment with provider and staff survey (Fall 2020)
Step 2: Implementation of SAGE training and provider education (Fall/Winter 2020) Step 3 (this study): Needs assessment with community-dwelling LGBT older adults (Spring 2021)

Improving Rates Of Nephrology Referral For Patients With Chronic Kidney Disease In Resident Clinic, Akanksha Arya, Md, Rabia Iqbal, Md, Rahed Mohammed, Md, Neveda Murugesan, Md, Jillian Zavodnick, Md

Health Equity and Quality Improvement (HEQI) Summit

• According to the KDIGO (Kidney Disease Improving Global Outcomes), evaluation by a nephrologist is recommended for patients with CKD stage 4 or higher (corresponding to a GFR of 30 or lower).
• Studies have shown that patients who are not referred to a nephrologist or referred later suffer from increased complications of renal disease, accelerated progression to ESRD, and have an increased overall mortality rate.
• At Jefferson Hospital Ambulatory Practice (JHAP), we noted decreased rates of nephrology follow-up in our patients with chronic kidney disease stage 4 and 5.
• We identified that the most prevalent reason for the decreased referral rates …

Reducing Delirium In Patients With Covid-19, Allison E. Brewer Mot/S, Amy Carver Mot/S, Allison Nance Mph, Mot/S, Mallori Rodrigue Mot/S, Olivia Smith Mot/S

Master of Occupational Therapy Student Critically Appraised Topics

The purpose of our critically appraised topic is to synthesize the best current evidence regarding interventions that would be effective in reducing delirium in patients with COVID-19 in the acute care setting. The final portfolio contains a total of five research articles. Study designs include three randomized controlled trials, one non randomized controlled trial, and one quasi-experimental quantitative design. All studies relate directly to interventions within the OT scope of practice and were implemented in the acute care setting. Due to limited research on the novel coronavirus, these findings apply to critically ill patients but are not specific to patients …

Preventing Pneumonia Through Early Mobilization Of Critically Ill Adults, Elizabeth G. Barton, Tedrin N. Elion, Caleb J. Harbor, Alexandria M. Keathley, Madison R. Payne, Hailey N. Warrington

Master of Occupational Therapy Student Critically Appraised Topics

The purpose of this critically appraised topic (CAT) is to investigate early mobilization and its effect on preventing pneumonia in adults in the intensive care unit (ICU). The final portfolio contains four research articles from both national and international journals. Study designs included two meta-analyses, one case series, and one retrospective study. All four of the articles specifically described the effects of early mobilization on individuals in the hospital and ICU and showed positive results in reducing the likelihood of developing pneumonia. This CAT will be used to draft new practice guidelines for mentoring new managers in both occupational therapy …

Increasing Confidence And Mental Health In Caregivers, Lucy D. Diangelo, Libby Lowry, Kayla Mcdaniel, Clare Sauser, Shelby Terry, Erin Williams

Master of Occupational Therapy Student Critically Appraised Topics

The purpose of our critically appraised topic is to synthesize the highest-level evidence available regarding interventions for increasing confidence and mental health outcomes in caregivers taking loved ones home from inpatient rehabilitation. The final portfolio contains six research articles from peer-reviewed journals. Study designs include randomized control trials, a systematic review, and a pretest-posttest without a control group. All studies relate directly to the components of the PICO question. Four of the articles discussed both caregiver confidence and mental health while two articles discussed only mental health. There is strong evidence to support that in-person hands on training, in person …

Space Retrieval Training For Memory Enhancement In Adults With Dementia, Lauren Camenzind, Molly Kafader, Rachel Schwam, Mikayla Taylor, Zoie Wilkes, Madison Williams

Master of Occupational Therapy Student Critically Appraised Topics

The final portfolio contains 8 research articles from national and international journals. Study designs include one systematic review, one randomized control trial with pretest-posttest design, three small-scale randomized control trials, one quasi-experimental study with no control, one time-series study, and one case study. All studies relate directly to components of the evidence-based practice question and will be used to draft new recommendations for implementation regarding spaced retrieval training for memory enhancement in adults with dementia. Seven out of the eight articles looked at the effects of SR techniques on functional tasks. Articles looked at eating difficulty (1), independent use of …

2021-05-27_Michigandaily_Covidmap, Michigan Department Of Health & Human Services

Daily Michigan COVID-19 Update

The "WHERE WE STAND WITH COVID-19" map was obtained from Michigan's main COVID-19 page: https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated daily at 3p.m., Monday - Saturday.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled.

The image contained a map, indicating total cases by county, and also provides statistics on Total Confirmed Cases, Total COVID-19 Deaths, Daily Confirmed Cases, and Daily COVID-19 Deaths. There …

Medical School Watercooler Newsletter - May 27, 2021, Lindsey Lyle

Watercooler Newsletter

This is the May 27, 2021 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents Include:

• Mark your calendar for grand rounds
• Register now: Diversity, equity and inclusion lecture series
• Meet a Med Student: Amber Crenshaw
• OB-GYN wins Best Clerkship Award for the first time in 24 years
• Faculty Spotlight: Hamayun Imran, M.D.
• Menger presents international talk on pediatric spinal deformity

Clinical Nurses Research Priorities In Hospital Settings: A Delphi Survey., Mariann Fossum, Marlene Z. Cohen, Vivi Haavik Tønnessen, Mette Dobler Hamre, Agno Lisbeth Vabo Ødegaard, Ingjerd Lind, Kari Olsen Håheim, Anne Opsal

Journal Articles: College of Nursing

This study aimed to identify the research priorities of clinical nurses to develop a research program at a health care services system that includes three hospitals. A Delphi survey was emailed to all clinical nurses in two rounds. The Delphi method was used to collect data from the nurses in regards to their priority research themes, and the data were analyzed using descriptive and comparative statistics. A total of 933 clinical nurses returned the first round of the Delphi survey and 543 nurses answered the second round. Clinical nurses identified 89 potential research themes. Patient safety and ethical challenges were …

2021-05-27_Michiganoverview_Covidbedppe, Michigan Department Of Health & Human Services

Michigan COVID-19 Hospital Data

Contains the tables Statewide Hospital Capacity Report for COVID-19, COVID-19 Metrics, Statewide Hospital Available PPE Tracking for COVID-19, as well as the tables PPE Days On Hand and Patient Census.

2021-05-27_Michiganoverview_Covidstats, Michigan Department Of Health & Human Services

Cumulative Michigan COVID-19 Data

The COVID Overview page was obtained from Michigan's main COVID-19 page: https:/www.michigan.gov/coronavirus/0,9753,7-406-98163-520743--,00.html.

The State of Michigan is working around the clock to test and treat COVID-19 patients. Below is the most recent data healthcare experts across the state have compiled. It is updated Monday - Saturday.
This report is provisional and subject to change. City of Detroit and Wayne County are reported separately. MDHHS began tracking probable cases April 5, 2020. FCI indicates federal correctional institute. MDOC indicates Michigan Department of Corrections. Diagnostic tests, including nucleic acid amplification/real-time polymerase chain reaction (NAAT/RT-PCR) and rapid virus antigen detection point of …

2021-05-27_Michiganoverview_Covidoutbreak, Michigan Department Of Health & Human Services

Michigan COVID-19 Outbreak Reports

The Outbreak Data page was obtained from Michigan's COVID-19 data page: https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173_102057---,00.html.

This report is created by the Michigan Department of Health & Human Services from data self-reported by local health departments. Data is updated every week.

COVID-19 outbreaks are generally defined as two or more cases with a link by place and time indicating a shared exposure outside of a household. Local health departments report the number of new and ongoing outbreaks they are investigating by the setting of the outbreak. New outbreaks are those outbreaks that were first identified during the current reporting week. Ongoing outbreaks are …