Medical Specialties Commons^™

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 …

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 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.

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.

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.

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

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

Aims for Improvement

Aim to decrease unnecessary use of serial imaging in sICH patients.

• This project plans to decrease the number of scans in this patient population while increasing faculty/staff satisfaction and efficiency of resource utilization.
• The goal is to decrease HCT utilization by 20% without compromising patient care or decision making.
• After finalizing and approving the HCT protocol, implementation of a trial period for two

Mitigation Of Ed Patient Boarding: Transferring Admissions From The Center City Ed To Methodist, Quinton Campbell, Md, Lauren Selame, Md, James Cirone, Do, Elizabeth Teixeira, Md, Jennifer White, Md, Frederick Randolph, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives:

• Objectively analyze transferred patient transfers cases as far as LOS (length of stay), final diagnosis, and transfer failure.
• Assess patient satisfaction with the transfer process as means to identify areas for improvement as well as potential patient safety issues.

Time To Defibrillation After Onset Of Ventricular Fibrillation And Ventricular Tachycardia Cardiac Arrest At Thomas Jefferson University Hospital And Jefferson Hospital For Neurosciences., Sairamya Bodempudi, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Improve average time to defibrillation after VFib/pVTach cardiac arrest to < 2 minutes within an 8 month interval at TJUH and JHN.
• Improve the percent of VFib/pVTach cardiac arrests that are defibrillated within the recommended 2 minute interval by 30% at TJUH/JHN within an 8 month interval

Exploring The Effectiveness Of Asthma Action Plans In Long-Term Asthma Management, Pankhuri Jha, Jessica Most, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Determine the efficacy of AAP in helping patients feel more confident in their self-management
• Improve asthma control by at least 10% after receiving an Asthma Action Plan

Experience With A Comprehensive Multidisciplinary Geriatric Oncology Center, Michael Weissberger, Md, Ms, Emma De Louw, Md, Kristine Swartz, Md, Lauren Hersh, Md, Andrew Chapman, Do, Facp

Health Equity and Quality Improvement (HEQI) Summit

Research Goals

1. 1. Describe the population seen in the SAOC over the past 6 years
2. Remediate and complete the EPIC flowsheets
3. Merge data with existing RedCAP data

Identifying Barriers To Statin Therapy In Diabetic Patients In A Large Ambulatory Practice, Jennifer Moyer, Md, Rachel Ehrman-Dupre, Md, Andrew Rabovsky, Md, Simon Newsom, Md, Pooja Padgaonkar, Md, Julita Mitchell, Md, Sarah Hirsh, Md, Madeline Taskier, Md, Robert Wiley, Md, Lilli Flink, Md, Greta Bires, Md, Geoffrey Mills, Md

Health Equity and Quality Improvement (HEQI) Summit

Aim 1: To understand the root cause(s) for gaps in statin therapy within a large ambulatory care practice.

Aim 2: To improve provider awareness of indications for statin therapy, as recommended by the ACC/AHA guidelines.

Aim 3: To increase the proportion of patients with diabetes at our practice that are on statin therapy.

Sglt2 Inhibitors In Patients With Diabetes And Cardiovascular Disease, Cristina Calogero, Md, Jillian Cooper, Md, Mathew Francis, Md, Joseph Grogg, Md, Shuwen Lin, Md, Patrick Prior, Md, Bo Hyung Yoon, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Problem Definition: Multiple studies (e.g. EMPA-REG, CANVAS) demonstrate that SGLT2 Inhibitors (Inh) improve cardiac outcomes in patients with Type II Diabetes (DM2) with comorbid Cardiovascular Disease (CVD) including Heart Failure and Coronary Artery Disease. SGLT2 Inhibitors are considered standard of care for patients with DM2 and CVD. Based on literature published in European Journal of Preventative Cardiology and JACC HF, our prediction is that physicians at Thomas Jefferson University Hospital Ambulatory Practices (TJUH) under-utilize SGLT2 Inh for patients with co-morbid CVD and DM2.

Aims for Improvement: Within the Jefferson Healthcare System, we sought to determine: Future Interventions

1. The percentage of …

Prevalence Of Gastrointestinal Symptoms In Patients With Cannabis Abuse Presenting To The Emergency Room, Hadiatou Barry, Md, Mph, Botros Shenoda, Md, Phd, Msc, Purujit Thaker, Md, Mary Naglak, Phd

Health Equity and Quality Improvement (HEQI) Summit

Introduction: Cannabis is a common recreational drug among young adults that is used to induce euphoria, promote relaxation and enhance appetite. There is a recognized correlation between cannabis abuse and cyclic episodes of nausea, vomiting, and abdominal pain (cannabinoid hyperemesis syndrome). However, the contribution of such symptoms to emergency room visits and hospital admissions is not known.

Methods: A one-year, retrospective study was conducted on patients who presented to the emergency department and were later admitted at Abington Hospital-Jefferson Health with confirmed cannabis use (positive urine drug screen).

Aim/Goal: Our primary outcome was to understand the prevalence of gastrointestinal symptoms …

Use Of Epic Emr For Early Identification And Management Of Patients At Risk Of Cardiac Implantable Electronic Device (Cied) Infection, Priya Rajagopalan, Md, Yair Lev, Md, Arnold J. Greenspon, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Aim of our project was early identification of 100% of patients with a CIED IMPLANT presenting with bacteremia
• Process involves use of EPIC EMR to automatically identify patients with positive blood cultures
• Traditionally, cardiologists are alerted by the care team using the CONSULT system for management of these patients
• EPIC EMR as an adjunct to the CONSULT system

Improving Evaluation And Follow-Up Of Patients Diagnosed With Left Bundle Branch Block, Naman Upadhyay, Md, Alvin George, Md, John Schanz, Ms, Behzad Pavri, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Left bundle branch block (LBBB) is a pathologic finding on electrocardiogram (ECG).

• Most commonly present in patients with antecedent hypertension, cardiac enlargement, coronary artery disease or a combination of these
• Class 1B recommendation: Those with findings of LBBB on ECG should undergo transthoracic echocardiography for evaluation of underlying heart disease
• LBBB is prevalent (33%) in patients with heart failure
• Cardiac resynchronization therapy can improve left ventricular mechanical function in patients with LBBB (QRS >150 msec)

This study aims to understand how effectively we are evaluating and following up these patients at Thomas Jefferson University Hospital.

The Echo Of An Unanswered Ring: Improving The Rate Of Reporting Abnormal Findings On Echocardiography At Tjuh, Tanuka Datta, Md, Bharaniabirami Rajaram, Md, Alvin George, Md, Madeleine Norris, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aim: To improve the rate of reporting abnormal echo findings verbally to primary patient care teams.

Goal: Increase the rate of attending reported abnormal echo findings to a patient's primary team by 75% in 6 months.

Does Discharge Pharmacy Affect Outcomes After Percutaneous Coronary Intervention?, Patrick Prior, Md, Lisa Moss, Abhinav Nair, Md, Preya Simlote, Md, David Fischman, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

To reduce the rate of this institution’s readmission rate in patients discharged after PCI, by identifying the current trends in readmission in relation to prescription and medication delivery practices over the past 1 year.

Optimizing Evaluation And Treatment Of Patients With Nausea And Vomiting Of Pregnancy In The Emergency Department, Danielle N. Carr, Md, Angela Carracino, Do, Alisha Sangal, Md, Madeline Smith, Md

Health Equity and Quality Improvement (HEQI) Summit

Problem Definition

• Nausea and vomiting of pregnancy (NVP). Approximately 50% prevalence rate
• Pregnant patients with NVP require special considerations for treatment
• Long ER wait times
• Possibly avoidable hospital admissions

Improving Blood Pressure Control Through Blood Pressure Measurement In An Ambulatory Urban Family Medicine Clinic, Sara Ancona, Md, Zachary Klock, Md, Aimee Mcmullin, Md, Zeynep Uzumcu, Md, Olivia Seecof, Md, Graham Stratton, Md, Alexa Waters, Md, Caitlyn Haines, Md, Brittany Hozick, Md, Jose Medina, Md, Geoffrey Mills, Md, Phd

Health Equity and Quality Improvement (HEQI) Summit

Aim Statement: To increase the percentage of patients over the age of 18 with BP controlled to a goal of <140/90 from a baseline of 58% to 68% by April 2020.

Changing Internal Medicine Residents’ Perspective On Social Determinants Of Health, Daniel Tran, Do, Hiba Ansari, Do, Layla Barrera, Do, Magdala Chery, Do

Health Equity and Quality Improvement (HEQI) Summit

Background: Social determinants of health (SDOH) shape the conditions of a person’s daily life and include factors such as housing, occupation, education, safety and income. While physicians are aware of the inequalities that exists in healthcare, not all physicians feel adequately able to address such concerns. Understanding of factors that contribute to the development and perpetuation of inequities in health care must be developed at the medical education training level.

Objectives: Evaluate internal medicine residents’ understanding of SDOH and implement a curriculum on health disparities in order to improve their comfort in addressing social needs.

Methods: A survey regarding several …

Urine Drug Screening At The Sleep Disorder Center, Rohin Saroya, Md, Karl Doghramji, Md

Health Equity and Quality Improvement (HEQI) Summit

Aim

• Introduce UDS for all patients undergoing MSLT or MWT
• Eliminate false positive and negative results
• Optimize management of disorder

Goal

• To have 100% of patients undergoing an MSLT or MWT to have a UDS

Assessing Internal Medicine Resident Comfort With Obtaining Consent For Autopsies, Zach French, Kelly Hughes, Edward Wang, Elizabeth Braden

Health Equity and Quality Improvement (HEQI) Summit

Objective

We aim to increase resident comfort and knowledge of the autopsy process by 20% based on average survey response scores

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

Health Equity and Quality Improvement (HEQI) Summit

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.

Time Value Analysis Of Inpatient Endoscopy Workflow, Sanaa Arastu, Md, Andrew Elden, Md, Raymond Janowski, Md, Aaron Martin, Md, Joseph Yoo, Md, Richard Denicola, Md, Amy Javia, Md, Melissa Vitolo, Md, Linda Yan, Md, Christopher Cao, Md, Scott Manski, Md, Christopher Schmoyer, Md, Brianna Shinn, Md, Mitchell Conn, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Our aim was to evaluate the variables involved in room turnover and identify any delays that lead to the time difference found between inpatient and outpatient rooms.
• We planned to design an intervention to improve efficiency in the endoscopy suite and complete more inpatient cases.
• We predicted that completion of more inpatient cases would subsequently decrease the need for cancellation and rescheduling of medically necessary cases on a daily basis.

Assisting Children With Velocardiofacial Syndrome Who Have Developmental Disabilities And Delays Associated With Speech, Communication, And Education, Mckenzie K. Holty

Honors Thesis

Children with velocardiofacial syndrome (VCFS) have a variety of complex needs. Research shows that VCFS is characterized by a combination of medical problems, developmental delays, and learning disabilities, which vary from child to child. This syndrome also puts adolescents at a higher risk for developing psychiatric and psychotic disorders. The complexity of symptoms that can arise from VCFS can influence the ability of these children to communicate, socialize, and learn effectively. This literature review aims to discuss literature for caregivers, educators, and physicians to aid children effectively and understand their challenges relating to speech, communication, and education. This topic is …