Medical Education Commons^™

Residency Recruitment: Changes And Challenges, Karen A. Chojnacki, Md, Facs

Department of Surgery Presentations and Grand Rounds

No abstract provided.

Jefferson Digital Commons Quarterly Report: July-September 2020, Kelsey Duinkerken, Msi, Larissa Gordon, Mslis, Med, Ma

Jefferson Digital Commons Reports

Included in this Report

• Abington Health Articles
• Articles
• Collaborative Healthcare: Interprofessional Practice, Education, and Evaluation (JCIPE)
• Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)
• Covid 19-: Spread the Science, Not the Virus
• Department of Family and Community Medicine Presentations and Grand Rounds
• Master of Population Health Program Thesis and Capstone Presentations
• Master of Public Health Thesis and Capstone Presentations
• Jefferson Surgical Solutions
• The Medicine Forum
• Sex and Gender Health Education Summit 2020
• Student Papers and Posters
• Misc. Uploads
• What people are saying about the Jefferson Digital Repository

Jefferson Digital Commons Quarterly Report: April-June 2020, Kelsey Duinkerken, Msi, Larissa Gordon, Mslis, Med, Ma

Jefferson Digital Commons Reports

This quarterly report includes:

• New Collection: COVID-19 Papers, Posters, and Presentations
• Articles
• Collaborative Research and Evidence Among Therapists and Educators (CREATE) Day Presentations
• COVID-19 Working Papers
• Dissertations
• Doctorate of Occupational Therapy (OTD) Capstones
• Educational Materials
• From the Archives
• Grand Rounds and Lectures
• House Staff Quality Improvement and Patient Safety Posters
• JeffMD Scholarly Inquiry Abstracts
• Journals and Newsletters
• Master of Public Health Capstone Presentations
• Posters
• Spread the Science, NOT the Virus Seminar Series
• What People are Saying About the Jefferson the Digital Commons

The Bulletin: Sidney Kimmel Medical College At Thomas Jefferson University, Volume 69, Issue 2, Summer 2020

The Bulletin (formerly the Jefferson Medical College Alumni Bulletin)

This issue includes:

• A Message from the President Facing Crises with Creativity
• Dean’s Column Difficult Times Define Us
• Jefferson COVID Stories
• Reflections from the Frontlines
• One Step of Many White Coats for Black Lives Peaceful Protest at Jefferson
• Time Capsule Philadelphia 1918: The Flu Pandemic Hits Home
• A Message from Elizabeth A. Dale Helping the Heroes
• Discovery Combating COVID-19
• Heroes on the Sidelines Sidelined from Patient Care, SKMC Students Find Purpose in Volunteer Work
• From the Front Lines to Online SKMC Doesn’t Miss a Beat in Medical Education
• Navigating Uncharted Waters in Search of the Class of 2024
• You’ve Got …

Zooming-Out Covid-19: Virtual Clinical Experiences In An Emergency Medicine Clerkship., Shruti Chandra, Chaiya Laoteppitaks, Nina Mingioni, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

In the setting of the novel 2019 coronavirus (COVID‐19) pandemic, it has been challenging to provide medical students in the Emergency Medicine (EM) clerkship meaningful clinical experiences that would meet clinical course goals and objectives, as well as satisfy Liaison Committee for Medical Education (LCME) requirements. During the EM clerkship, students play an integral role in interviewing patients, formulating treatment plans, facilitating patient discharges, and counseling patients. Immediately available direct and indirect supervision are paramount to ensure student learning and safe patient care. The authors present a novel clinical educational experience for senior medical students in an EM clerkship that …

Implementing A Surgical Pre-Operative Checklist: Improving Transparency & Communication, Ritam Ghosh, Md, James Harrop, Md, Jesse Edwards, Md

Health Equity and Quality Improvement (HEQI) Summit

Our goal was to first analyze what the current practice was and if there was a need for improvement. To our knowledge, each surgical service has its own preop protocol and this is not standardized across the hospital. Furthermore, very few services have EPIC based protocols that allow for documentation and information sharing. For example, the neurosurgery service uses paper checklists, a style that is effective yet outdated.

A survey was sent out to multiple departments in order to gauge the current landscape of pre-operative care. Questions were posed to analyze if there was a need for improved documentation by …

Asymptomatic Fluid Collections Following Distal Pancreatectomy – Is Intervention Warranted?, Elwin Tham, Md, Emily Papai, Ms, David Nauheim, Ms, Michael Morano, Ms, Nicole Wagner, Ms, Shawnna Cannaday, Crnp, Theresa P. Yeo, Phd, Geoffrey Krampitz, Md, Phd, Charles J. Yeo, Md, Harish Lavu, Md

Health Equity and Quality Improvement (HEQI) Summit

Objective

To determine the incidence, associated factors, natural history, and interventions for FCs.

Stepwise Implementation Of Vaginal Cleansing And Azithromycin At Cesarean Delivery To Decrease Postoperative Infections; A Quality Improvement Study, Julie Gomez, Ms, Johanna Quist-Nelson, Md, Laura Felder, Md, Daniele Dimascio, Md, Rebecca Eckler, Md, Amanda Paternostro, Md, Michael Posencheg, Md, Jason Baxter, Md, Vincenzo Berghella, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

We aimed to decrease our SSI rate by 30% by sequential implementation of vaginal cleaning1,2 and azithromycin3 for women who underwent a CD after having labored or experienced rupture of membranes.

Post-Operative Atrial Fibrillation And Anticoagulation, J. Vojnika, Md, P. Varano, Md, S. Melnick, Do, Matthew Metzinger, Mba, Cphq, K. Patel, Rn, Msn, Mba, Cphq

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Overall aim: Improve recognition of need for anticoagulation in post-operative atrial fibrillation.

• Increase recognition that thromboembolic risk in post-op atrial fibrillation is similar to that of non-valvular atrial fibrillation
• Increase the rate of appropriate anticoagulation initiation in patients with post-op atrial fibrillation

Identifying Women With Coronary Artery Disease Using Non-Cardiac Ct Imaging, Rachel Redfield, Md, Rani Rajaram, Md, Kathryn Anderson, Ba, Sarah Kamel, Md, Matthew Metzinger, Mba, Lydia Liao, Md, Katherine Sherif, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims

• Identify the percentage of female patients with prior CT scans done for noncardiac reasons who should have the diagnosis of CAD.
• Collaborate with primary care, cardiology and breast imaging to determine how best to integrate this incidental finding into clinical practice.
• Determine current barriers that may prevent providers from taking action on patients with new CAD.

Detection Of Coronary Artery Disease On Ct Chest Imaging, K. Mirzozoda, Md, Mba, J. Vojnika, Md, R. Mohammed, Md, H. Landon, Md, C. Murphy, Y. Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Overall aim: Improve diagnosis and management of CAD based on CT chest imaging.

• Improve diagnosis of silent CAD based on CT chest imaging: more patients who have findings of CAC on CT chest imaging will be diagnosed with CAD.
• Increase the number of appropriate statin prescriptions based on CAD findings on CT chest imaging.

Use Of Visual Aids In Improving Immunization Rates, Kuljit Kaur, Do, Jennifer Brennan, Do, Manuela Modelowski, Do, Olubunmi Olarewaju, Do, Anthony Abbruzzi, Do

Health Equity and Quality Improvement (HEQI) Summit

We assessed the use of visual aids in vaccine administration in the outpatient setting. Specifically, our objective was to determine if placing visual aids outlining vaccine guidelines in the adult outpatient primary care office would increase the compliance rate of immunizations; and if so, to what degree.

Obstacles To Nurse-Performed Ultrasound Guided Peripheral Iv Placement, Ali Elsaied, Do, Farhan Khan, Do, Rishi Kalwani, Md, Cara Kanter, Md, Kenn Ghafferian, Do

Health Equity and Quality Improvement (HEQI) Summit

With an aging population, the rate of obesity, the regional prevalence of dialysis patients and the increase in IV drug abuse, obtaining routine vascular access in the emergency department (ED) has become more challenging. Ultrasound (US) guided IV placement has been pivotal in identifying deeper veins to access. This is traditionally performed by ED physicians, however given the time constraints, lower acuity patients who require US IV access can experience significant delays to care. We attempted to train ED nurses to perform this skill, however many trained nurses are still not attempting US IVs regularly. This study aimed to identify …

Process Design For Optimizing Text-Based Communication Between Physicians And Nurses, R. Benson Jones, Md, Jane Khalife, Md, Brittany Heckel, Md, Michelle Hannon, Md, Guy Katz, Md, Sonia Bharel, Md, Richard Schmidt, Md, Riti Kanesa-Thasan, Md, Kevin Hines, Md, Timothy Kuchera, Md, Joshua Levin, Md, Christian Fernandez, Md, Emma Lundsmith, Md, Rebecca Jaffe, Md

Health Equity and Quality Improvement (HEQI) Summit

Background and Aim

• Communication between physicians and nurses is a cornerstone of high-quality inpatient care.
• HIPAA-compliant text-based methods offer an alternative to the pager for communication between nurses and physicians.
• While messaging is popular in the personal setting, text-based professional communication in hospitals may increase the number of messages without improving coordination between care providers. (1)
• In addition, urgent messages that are more appropriately calls could be missed by the physician, leading to a delay in action. Other institutions use triage systems to communicate a question or clinical change by the urgency of expected physician response, which have attempted to …

Standardizing Postoperative Handoffs Using The Evidence-Based Ipass Framework Improves Handoff Communication For Postoperative Neurosurgical Patients In The Neuro-Intensive Care Unit, Richard F. Schmidt, Md, Matthew D. Vibbert, Md, Coleen A. Vernick, Do, Andrew M. Mendelson, Do, Caitlin Harley, Msn, Giuliana Labella, Msn, Jessica Houser, Bsn, Patrick Becher, Bsn, Erin Simko, Bsn, Pascal M. Jabbour, Md, Stavropoula I. Tjoumakaris, Md, M. Reid Gooch, Md, Ashwini D. Sharan, Md, Christopher J. Farrell, Md, James S. Harrop, Md, Robert H. Rosenwasswer, Md, Rebecca C. Jaffe, Md, Jack Jallo, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Within one year of initiation of the process improvement plan, we wanted to improve:

• Direct communication of airway and hemodynamic concerns
• Direct communication of operative events, complications, and perioperative management goals.
• Attendance at postoperative handoffs
• Confirmation of information by receiving teams
• Staff perceptions of handoff efficacy and teamwork.

Preventing Prostate Biopsy Complications: To Augment Or To Swab?, L. Glick, S. Vincent, T. M. Han, C. Caputo, D. Squadrito, J. Y. Leong, C. Fonshell, K. Syed, J. F. Danella, S. Ginzburg, T. J. Guzzo, M. Hagg, J. D. Raman, M. Smaldone, R. G. Uzzo, J. J. Tomaszewski, A. C. Reese, E. J. Trabulsi, L. G. Gomella, M. J. Mann

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• The aim of this study was to determine the antibiotic prophylaxis associated with the fewest infectious complications following prostate biopsy
• Determining the safest method allows the Jefferson Department of Urology to modify its biopsy protocol and improve the rate of post-biopsy complications

Hepatitis A Vaccination Program In Jefferson Emergency Departments, Katelyn Levy, Md, Belinda Lao, Md, Mitchell Berman, Md, Joseph Jean, Md, Sejal Patel, Pharmd, Benjamin Slovis, Md, Scott Sutherland, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Increase the rate of hepatitis A vaccination in high-risk patients (homeless and drug users) who present to Thomas Jefferson University Hospital and Jefferson Methodist emergency departments over a 5 month period starting on 9/4/2019.

Improving Outpatient Pneumococcal Vaccination Rates In Patients Age <65, Evan Nardone, Md, Mark Mallozzi, Md, Alvin George, Md, Christine Kurian, Md, Omar Safdar, Md, Timothy Kuchera, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• To increase pneumococcal vaccination rates for patients 19-64 at JHAP to reach 70% over 3 months.
• To increase resident knowledge of indications for pneumococcal vaccination in patients 19-64 by 25% over 3 months

Improving Osteoporosis Screening Rates In A Primary Care Practice Using An Emr-Based Intervention, Conor Murphy, Ashley Barnes, Rukaiya Bashir, Peter Block

Health Equity and Quality Improvement (HEQI) Summit

Objective

• Osteoporosis is defined as a T-score ≤ -2.5 on DEXA or history of fragility fracture
• Affects a significant proportion of our population over 65 with an estimated annual cost burden of $22 billion
• Only 46% of females over 65 years of age had been screened for osteoporosis at JHAP
• Our study aims to increase that percentage between July 2019 and July 2020 from 46% to 60%

Quick Response (Qr) Code Based Just-In-Time Training Platform For Seldom Used Anesthesia Equipment, Daniel Katz, Do, Sean Washek, Do, David Barnabei, Do, Andrea Creamer, Md, David Nelson, Md, Mba

Health Equity and Quality Improvement (HEQI) Summit

Aim for Improvement

This quality improvement initiative aims to introduce, improve, and maintain proficiency with seldom used critical pieces of anesthesia equipment prior to use in emergent clinical situations through the following

• Provide just-in-time usage instructions through smartphone technology
• Remove barriers that lead to unfamiliarity with rarely used equipment, we hope to reduce patient safety incidents due to improper usage

The aim was to improve the department’s familiarity and self-reported competence with seldom used equipment by at least 50%

General Surgery Mobile Procedure Cart: Providing Safe And Efficient Procedure Based Care To The Bedside, Ryan Lamm, Ellen Caparosa, James Fraser, Lindsay Lynch, Uzma Rahman, Lindsay Weil, Harish Lavu

Health Equity and Quality Improvement (HEQI) Summit

Objective

To create a mobile supply cart with all necessary supplies needed for the most common general surgery bedside procedures in order to decrease the amount of times residents need to “shop” for supplies from other locations and prevent delays in procedures to get supplies that are not available. In turn, this will increase patient safety and quality of procedure-based care delivered.

Reading Room Assistance Pilot: Improving Radiologist Workflow, Michael Hoy, Md, Christopher G. Roth, Md, Ms-Hqs, Rashmi Balasubramanya, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Our aim for improvement was to find ways to decrease distractions and phone calls in the body radiology reading room and to convert unpredictable and “immediate-response distractions” to “managed distractions” that can be addressed without aborting patient care/case interpretation immediately and unnecessarily. The goal was to decrease interruptions which would allow more time to be spent on reading cases, learning, and teaching. One metric that we identified was the number of phone calls to the reading room, which we intend to decrease by 50% within the first quarter. Another metric was the radiology attending and resident attitudes …

Improving Patient Safety Through A Postoperative Debriefing Initiative, Ellina Hattar, Md, Monica Young, Dnp, Mba, Rn, Cnor, Erin Leonetti, Rn, Omaditya Khanna, Md, Anthony Stefanelli, Md, James Harrop, Md, Ashwini Sharan Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Effective and clear communication in the operating room is a necessary aspect of any surgery. Every member of the operative team is integral in fostering an environment focused on patient safety. As such, the institution of a postoperative debrief session may allow for feedback from every member of the team that will ultimately aid in improving a patient’s experience.

Early Follow-Up Phone Calls To Reduce 30-Day Readmissions For Stroke Patients Discharged To Home, Olivia Gruder, Md, John Allred, Md, Frank Anzelmi, Md, Judy Diep, Md, Belle English, Md, Aniket Natekar, Md, Priyadarshee Patel, Md, Louis Porreca, Md, Sanskruti Patel, Md, Shaista Alam, Md, Rodney Bell, Md, Robin Dharia, Md, Elan Miller, Md, Diana Tzeng, Md, Fred Rincon, Md< Msc, Facp

Health Equity and Quality Improvement (HEQI) Summit

Patients admitted to the acute stroke unit with minor neurologic deficits are frequently discharged directly to home rather than to a rehabilitation center. Data from our tertiary care comprehensive stroke center has shown that in a 7-month period, 37% of patients admitted to the stroke unit were discharged home versus discharged to rehab or other location. Our average 30-day readmission rate for home discharges is 5.14%. More than 30% of these readmitted patients had been discharged on a Thursday or Friday on their index admission. When discharged home, patients typically are tasked with several responsibilities including but not limited to …

Developing A Home Based Chemotherapy Model, George Xiangyun Ye, Nathan Handley, Md, Mba, Maria Piddoubney, Pharmd, Gloria Espinosa, Pharmd, Judith Alberto, Pharmd, Adam Binder, Md

Health Equity and Quality Improvement (HEQI) Summit

Lessons Learned

• Based on our criteria, most medications can be administered in the home setting.
• A major barrier to administration at home is stability of medications at room temperature. This issue can be addressed by transporting and storing the medication in a refrigerated container.
• Expectedly, injectable drugs and medications with short infusion times that are stable at room temperature would be easiest to administer at home.

Strengthening The Synapse Between Outpatient Neurological Care And Inpatient Referral, T. Y. Chuang, M. Braslavsky, E. Isaac, M. Rehman, C. S. White, S. Thummalapenta, P. Kerns, D. Rose, E. Wong

Health Equity and Quality Improvement (HEQI) Summit

Objective

The goal of this project is to investigate if established neurology patients are appropriately referred to the emergency room. We suspect that there are patients that could be more effectively triaged to prevent unnecessary visits to the emergency department. If this is the case, implementing an intervention such as offering expedited visits or contingency plan, may reduce non-emergent inpatient consultative services5. This would also improve outpatient communication and decrease utilization of both ER and patient resources.

Simple Frameshifts In Mis Postoperative Pain Management Significantly Reduce Opiate Prescriptions, L. Glick, D. Wong, T. M. Han, J. Y. Leong, A. Uhr, J. R. Mark, M. J. Mann, E. J. Trabulsi, C. D. Lallas, T. Chandrasekar

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• The intervention aimed to reduce narcotics provided to patients after MIS by reducing number of narcotic prescriptions and amount prescribed by 25% without affecting patientreported pain scores
• Usage measured in Morphine Equivalent Doses (MED)
• MED and pain score assessed at 3 time points: post-op day 1 (POD1), discharge (D/C) and follow-up (FU) apt
• Pre- and Post-intervention cohorts - Month 1 (Pre-intervention): 21 patients and Month 2 (Post-intervention): 30 patients

Small Bowel Obstruction: Facilitating Diagnosis And Optimizing Resuscitation And Management, Quinton Campbell, Md, Ryan Bateman, Md, Alex Mercado, Do, James Cirone, Do, Robin Naples, Md

Health Equity and Quality Improvement (HEQI) Summit

Objective

• Standardize practice patterns and improve consistency in procedure documentation in ED management of Small Bowel Obstruction (SBO)
• Significant practice variability exists among ED providers for SBO management, specifically in regard to utilization of diagnostic imaging as well as rates of NG tube (NGT) placement and subsequent documentation
• Data review performed by our group demonstrated that of all NG tubes placed, only 61% were documented
• Wide range of practice patterns for diagnostic imaging (see graphics in Results)

Thoracostomy Tube Placement: Resident Experience And Confidence At A Large Academic Medical Center, Lisa A. Bevilacqua, Md, Prashanth Palvannan, Md, Mph, Meryl Abrams, Md, D. Brock Hewitt, Md, Mph, Kory London, Md, Francesco Palazzo, Md, Tyler Grenda, Md

Health Equity and Quality Improvement (HEQI) Summit

The goal of this study was to investigate TT placement patterns and resident confidence at one academic medical center. In addition, our second objective was to gather quantitative data on the frequency and context of TT placement, rates of complications, and factors associated with complications among residents at TJUH.

Development Of Interdisciplinary Communication Tools To Improve Handoffs For Emergent Airway Management, Aaron Ocker, Do, Daniel Katz, Do, Jason Kopenitz, Do, Daniel Casey, Alexander Olson, Anna Rabinowitz, Md

Health Equity and Quality Improvement (HEQI) Summit

Project goal

Improve response time from airway alert to intubation while ensuring pertinent critical patient information is communicated to the airway team to reduce negative patient outcomes and better mobilize anesthesia resources.