Medical Specialties Commons^™

Quality Of Icu Discharge Summaries Produced By Pediatric Residents: The Memorial Health University Medical Center Experience, Jessica M. Lee, James Ryden, Emma Meehan, Eric Shaw, Mary C. Lytle, Andrew Stack, Ashley Shearman

HCA Healthcare Journal of Medicine

Background

Discharging intensive care unit (ICU) patients directly home is becoming more common. High-quality ICU discharge summaries are crucial in the transition of patient care. Currently, at Memorial Health University Medical Center (MHUMC), there exists no standardized ICU discharge summary template or consistency when discharge documentation is completed. Investigators evaluated the timeliness and completeness of ICU discharge summaries at MHUMC produced by pediatric residents.

Methods

A single-center retrospective chart review of pediatric patients discharged directly from a 10-bed Pediatric ICU to home was conducted. Charts were evaluated pre- and post-intervention. The intervention included the implementation of a standardized ICU discharge …

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …

Nurse-Initiated Treatment Reduces Costs For Acute Asthma In A Pediatric Emergency Department, Michael D. Johnson Md, Ms, Minkyoung Yoo Phd, Richard E. Nelson Phd, Amanda K. Nielson Md, Lauren Allen Mas, Nanette Dudley Md, Brandon Andersen Rrt, Amanda Orme Dnp, Cpnp-Ac, Cameron Mcfarland Np-C, Michael Mundorff Mba, Mhsa

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Standardized emergency department (ED) pathways can improve care delivery to children with acute asthma, though their impact on hospitalization and costs is unclear. An Acute Asthma Care Pathway (AACP) that facilitates nurse initiation of treatment was implemented at a tertiary care pediatric ED using standard quality improvement methodology. The impact of implementation was assessed using process control methodology and multivariable time series analyses between pre- and post-implementation periods. Provision of a steroid within 30 minutes and 60 minutes of arrival increased by 21 and 22 percentage points respectively, IV magnesium sulfate administration increased by 30 percentage points, the proportion hospitalized …

Outcomes Of Asthma Quality Improvement In Pediatric Patients, Kathryn M. Murray Md, Faap

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction. The Utah Pediatric Partnership to Improve Healthcare Quality (UPIQ) and Utah Department of Health (UDOH) Asthma Program Learning Collaborative is a quality improvement initiative designed to standardize asthma care in pediatric patients and improve the overall assessment and patient education process for both healthcare providers and patients. The aim of the Asthma QI Project was to improve the diagnosis and management of asthma for patients in the state of Utah by implementing a standardized approach to the identification and treatment of patients with asthma.

Methods. Patients scheduled to see a healthcare provider at our pediatric clinic were screened for …

Getting Ahead: A Resident Led Quality Improvement Project To Increase Diabetic Nephropathy Screening In An Underserved Hispanic-Predominant Population, Stephanie Luu, Jose Rivera, Daniel Aragon, Victor Zamora, Irma Huayanay, Reham Majzoub, Andreina Baird, Cristina Escobar, Eric Sanchez, Juan Carlos Lopez-Alvarenga, Daniela Hernandez, Chelsea Chang

Journal of Community Hospital Internal Medicine Perspectives

Introduction: Diabetes is the leading cause of end-stage renal disease (ESRD) in the United States (US), with 37 million having chronic kidney disease. Despite national guidelines recommendations for diabetic nephropathy screening with urine albumin-to-creatinine ratio (UACR), less than 50% receive full screening.

Our Internal Medicine residents led a quality improvement project to increase diabetic nephropathy screening rate with UACR in our resident clinic by 50% in one academic year.

Methods: We conducted the resident-led quality improvement project from July 2021 to April 2022. We reviewed the electronic medical records (EMR) from our clinic pre-intervention July 2020 to June 2021 and …

Improving The Accuracy Of Interactive Voice Response (Ivr) Technology For Pediatric Experience Scores, Elizabeth Spaargaren Ms, Mph, Cpxp, Abigail Kozak Mba, Cpxp, Cara Herbener Cpxp, Barbara Lawlor Burke Ma, Cpxp

Patient Experience Journal

The increased use of interactive voice response (IVR) in assessing patient and family experience should be paired with evidence-based practices on how to obtain the most accurate information via this survey mode. We added a brief clarification sentence of the survey scale at the start of the IVR call to improve our experience data both qualitatively and quantitatively. Our setting was an urban pediatric hospital. We gathered lived experiences from our patients, families, and providers to understand and design a change to the IVR survey mode that would reduce survey inaccuracies. Outcome measures were assessed by baseline measurement and post-intervention …

The Impact Of Follow-Up Calls After A Pediatric Emergency Department Visit, Joseph R. Mijares Iii, Sephora Morrison

Patient Experience Journal

Pediatric emergency department (ED) visits can be a stressful time for patients and their caregivers. This high stress environment can lead to questions and needed clarifications post-discharge. We implemented a post-discharge callback system to resolve these concerns for a focused subset of patients who historically have provided the most negative comment feedback on ED patient experience surveys. We hypothesized that comment types would shift to more positive than negative and the themes of the comments received would change. We developed a discharge callback process that focused on patients who were triaged as ESI level 4 during their emergency department visit. …

Asking The Question ‘What Matters To You?’ In A London Intensive Care Unit, Harriet Pittaway, Laura White, Karen Turner, Angelique Mcgillivary

Journal of Patient-Centered Research and Reviews

Purpose: At the heart of the paradigm shift in approach to patient care from paternalism toward shared decision-making lies the international “What Matters To You?” (WMTY) movement. However, WMTY principles are not frequently applied to the critical care setting. The aim of this quality improvement project work was to design and integrate a tool for all patients admitted to the intensive care unit (ICU) that helped answer WMTY.

Methods: Using Plan-Do-Study-Act (PDSA) methodology across 8 cycles, a multidisciplinary team designed and integrated a bedside poster into the ICU. Quantitative and qualitative data were collected via a bedside audit process on …

Increasing Naloxone Co-Prescribing Among At-Risk Individuals: Evaluation Of A Quality Improvement Project In A Large Health System, Sarah Hemphill Ba, Kristen Silvia Md, Marc D. Kimball Md

Journal of Maine Medical Center

Background: Naloxone availability and early administration is key in preventing death following opioid overdose. The CDC advises that naloxone should be made available to all at-risk individuals. In 2017, providers at Maine Medical Center noted that only 6% of at-risk patients had naloxone prescriptions

Methods: Included in this study were all patients of MaineHealth, a health system comprising 9 hospitals and 30 primary care practices, serving approximately 1.1 million patients. Between 2017 and 2020, we implemented several system-wide quality improvement interventions to increase rates of naloxone co-prescribing among at-risk individuals. Risk factors included prescribed opioids ≥50 morphine milligram equivalents, concurrent …

Care Alert Program In Chronic Recurrent Ed Utilizing Patients, Kaitlyn Phelps, Jonathan Bryan, Jonathan Leggett, Erica Gibbons, Brian Griggs

HCA Healthcare Journal of Medicine

The Care Alert program is designed to help navigate encounters with patient populations that are high utilizers of emergency department (ED) resources. These populations often have chronic medical conditions, have a poor understanding of their conditions, are unfamiliar with the EDs’ role in the management of these conditions, and commonly lack outpatient resources. The Care Alert program intends to address the needs of this challenging patient population by designing individualized care plans that are approved through a multidisciplinary committee. Data from this study showed a 37% decrease in ED visits and a 47% decrease in hospitalizations during the initial 8 …

Language Preference Impact On The Outcomes Of Those Lost To Follow-Up After A Diagnosis Of Pregnancy Of Unknown Location, Erin A. Leestma, Mayra A. Shafique, Megan Mcnitt, Annmarie Vilkins

Medical Student Research Symposium

Pregnancy of unknown location (PUL) is a temporary diagnosis when there is a positive pregnancy test but an intrauterine gestational sac and/or fetal pole are not visualized with ultrasonography. The three potential outcomes for such a pregnancy are failed pregnancy, an early intrauterine pregnancy or an ectopic/abnormal pregnancy. Given the serious associated morbidity of ectopic pregnancy, these PUL require strict follow up of bHCG levels to help the clinician determine the likely outcome of the PUL (failed vs early vs ectopic) and choose the best intervention (expectant management, surgical management or medical management). One potential barrier to follow-up identified in …

Optimizing Oxygen Therapy, Gizam Gokalp, Ramez Massoud, Jopher Bernal, Guru Chinnaraj, Michael Delzoppo, Nicole Brenner

North Florida Division GME Research Day 2022

No abstract available.

Implementation Of Delirium Bundle On A Hospital Medical/Surgical Unit To Help Decrease The Prevalence Of Delirium, Sanusi Mohammed

Doctor of Nursing Practice Scholarly Projects

Description of the Problem: Delirium is defined as a constellation of symptoms that includes disturbance in attention or awareness, change in cognition, language and perceptual disturbances that develops over a short period of time. Delirium mostly affects adult patients with risk factors including history of dementia, early cognitive impairment, dehydration, and infections. This quality improvement project was implemented on one hospital unit at a large tertiary hospital in the Boston area. This unit has one highest rate of delirium in the entire hospital system. Delirium is associated with high rate of morbidity and mortality. Also, this syndrome leads to longer …

When Healthcare Leadership And Philanthropy Lead To An Improved Patient Experience: The Paul Lepsoe Music Initiative, Sara Olivier Rn Bscn Mn, Corianne Bell Ba Mus, Cheryl Jones Registered Psychotherapist, Mta, Phd, Jerry M. Maniate Md, M.Ed, Frcpc, Facp

Patient Experience Journal

Through an unprecedented collaboration between an academic acute tertiary care hospital (The Ottawa Hospital (TOH) and a community-based professional orchestra (Ottawa Symphony Orchestra (OSO), the Paul Lepsoe Music Initiative represented an innovative partnership focused on improving patient care via (a) the integration of live music in waiting areas of the hospital’s Cancer Center and (b) the creation of individualized music therapy interventions on the inpatient Palliative Care Unit. Patient, family, and volunteer/staff feedback further refined the intervention throughout the duration of the Initiative; a qualitative process that provided insight into the overall patient experience and opportunities for patients and families …

Patient Reported Experience In A Radiation Oncology Department, Demetra Yannitsos, Petra Grendarova, Abdulla Al-Rashdan, Linda Watson, Wendy Smith, Fiona Lochray, Jackson Wu, Lisa Barbera

Patient Experience Journal

Understanding patient experience is essential to providing high quality, person-centered care. A real-time baseline cross-sectional study was completed to identify gaps in patient experience that can be targeted for quality improvement (QI). This study is part of PROSE (Person-centered Radiation Oncology Service Enhancement), a QI initiative developed to improve patient experience at a tertiary cancer centre Radiation Oncology (RO) Department. Data was collected using the Your Voice Matters (YVM) questionnaire. The YVM captures information on the patient’s last visit, and questions are organized based on dimensions of person-centered care. Recruitment occurred between May and August 2019 in the radiation department. …

Barriers, Access And Management Of Paediatric Epilepsy With Telehealth., Kari Gali, Sucheta Joshi, Sarah Hueneke, Alexis Katzenbach, Linda Radecki, Trisha Calabrese, Linda Fletcher, Cristina Trandafir, Carey Wilson, Monisha Goyal, Courtney J. Wusthoff, Jean-Baptist Lepichon, Rhonda Corvalan, April Golson, Jessica Hardy, Michael Smith, Elizabeth Cook, Joshua L. Bonkowsky

Manuscripts, Articles, Book Chapters and Other Papers

Access to paediatric neurology care is complex, resulting in significant wait times and negative patient outcomes. The goal of the American Academy of Pediatrics National Coordinating Center for Epilepsy's project, Access Improvement and Management of Epilepsy with Telehealth (AIM-ET), was to identify access and management challenges in the deployment of telehealth technology. AIM-ET organised four paediatric neurology teams to partner with primary-care providers (PCP) and their multidisciplinary teams. Telehealth visits were conducted for paediatric epilepsy patients. A post-visit survey assessed access and satisfaction with the telehealth visit compared to an in-person visit. Pre/post surveys completed by PCPs and neurologists captured …

Evaluating The Effect Of Neuraxial Analgesia On External Cephalic Version Success, Sarah Dreibelbis, Peter F. Schnatz, Edwin Newton

Transformative Medicine (T-Med)

Abstract

Background: External cephalic version (ECV) can be a helpful procedure in attempts to decrease the overall cesarean section rate. ECV involves the application of external pressure to the pregnant woman’s abdomen in attempts to turn the fetus to a vertex presentation and allow for subsequent vaginal delivery. Tocolytics are routinely used to increase ECV success rates, and neuraxial analgesia has been presented as another adjunct to increase overall success. The purpose of this quality improvement project is to evaluate the effect neuraxial analgesia may have on ECV success rates.

Methods: Patients scheduled for ECV between the dates of January …

Implementation Of A Drive-Through Covid-19 Mass Vaccination Site: Experiences From Louvax–Broadbent In Louisville, Kentucky, Ruth Carrico, Sarah Beth Hartlage, Valenchia Brown Msn, Aprn, Fnp-C, Sarah M. Bishop, Luanne Didelot, William Hayden, Beverly Williams Coleman, Sarah Tan, Delanor Manson, Kellie Kane, Dawn Balcom, Paul Kern

The University of Louisville Journal of Respiratory Infections

Background: Response to the COVID-19 pandemic has required innovative approaches to vaccination, including methods to rapidly and safely immunize communities. A major challenge to such a response involved access to untapped healthcare worker resources. The Louisville, Kentucky, response involved the use of a large volunteer workforce to supplement local public health employees in planning and implementing a large-scale drive-through vaccination event. The objective of this manuscript was to outline processes involved in training a mass immunization workforce and implementating a large-scale COVID-19 community vaccination.

Approach: Competency-based and standardized training was provided for every volunteer before working their shift. Volunteers worked …

Catheter-Associated Urinary Tract Infections: Patient Characteristics, Treatment, And Clinical Outcomes In One South Texas Acute Care Hospital, Kimberly A. Ambrosini, Jose Campo Maldonado

MEDI 9331 Scholarly Activities Clinical Years

Background: Catheter-associated urinary tract infections (CA-UTIs) account for 40 percent of nosocomial infections worldwide. Their elimination is at the forefront of quality improvement in one South Texas acute care hospital.

Methods: Over a period of 6 months, five CA-UTIs occurred in one South Texas acute care hospital. These cases were identified via regular surveillance by Infection Prevention staff and the Laboratory Department of the hospital. This research reviews patient age, sex, length of stay, bacteria contracted, appropriate antibiotic use, patient characteristics, and overall outcomes.

Results: Between the months of July and December 2021, 5 CAUTIs were contracted. Patients …

Perioperative Registries In Resource-Limited Settings: The Way Forward For Pakistan, Usama Waqar, Shaheer Ahmed, Ayesha Nasir Hameed, Namrah Aziz, Hina Inam

Medical College Documents

Capable of improving surgical quality, perioperative registries can allow performance benchmarking, reliable reporting and the development of risk-prediction models. Well established in high-income countries, perioperative registries remain limited in lower- and middle-income countries due to several challenges. First, ensuring comprehensive data entry forums to power the registries is difficult because of limited electronic medical records requiring sustained efforts to develop and integrate these into practice. Second, lack of adequate expertise and resources to develop and maintain registry software necessitates the involvement of software developers and information technology personnel. Third, case ascertainment and item completion are challenging secondary to poor-quality medical …

Implementation Of An Outpatient Hd-Mtx Initiative, Kelsey Sokol, Kelley Yuan, Maria Piddoubney, Ellen Sweeney, Anne Delengowski, Katlin Fendler, Gloria M. Espinosa, Judith Alberto, Patricia Galanis, Carol Gung, Meghan Stokley, Mercy George, Mary Harris, Ubaldo E. Martinez-Outshoorn, Onder Alpdogan, Pierluigi Porcu, Adam Binder

Department of Medical Oncology Faculty Papers

Introduction: Methotrexate (MTX) a folate antagonist is often given in high doses (≥500 mg/m2) to treat a variety of disease processes. While inpatient administration has been the norm, outpatient administration, has been shown to be safe, effective, and patient centered. Here in we describe development of an outpatient HDMTX protocol and our initial experience.

Methods: All patients were to receive their first cycle of HDMTX in the hospital to ensure they tolerate it well and also to use this time to assist in training for home administration. The outpatient protocol involved continuous IV sodium bicarbonate, along with oral leucovorin and …

Increasing The Rate Of Pneumococcal Vaccination In Patients Over 65 At Hca Florida Osceola Primary Care, Ubaldo Gonzalez Morales, Muna Alhusban, Chelsea Guan, Natalia Cavin, Humeyra Dogan, Allison Ferrara

North Florida Division GME Research Day 2022

No abstract available.

Implementation Of Standardized Protocols For Office Blood Pressure Measurement, Steven Nevers, Alice Tran, Carol Gambrill, Anush Pillai

Gulf Coast Division GME Research Day 2022

No abstract provided.

A How-To Toolkit For Teaching Residents Common Musculoskeletal Injections Performed In Prinary Care, Elizabeth Suniega, Anush Pillai

Gulf Coast Division GME Research Day 2022

No abstract provided.

Implementing A Delirium Precautions Order Set At Osceola Regional Medical Center, Marisa Taddeo, Gabriella Meyerson, Israel Taylor, Monica Arias Garcia, Sonia Dela Cruz, Katrina Kesterson

North Florida Division GME Research Day 2022

No abstract available.

Improving Recombinant Zoster Vaccination Rates In Patients Receiving Biologic Therapy In The Rheumatology Clinics At The Orlando Va Healthcare System, Kathlyn Camargo Macias, Taylor Kann, Marilyn Mosquera, Ravi Shahu Khal, Ashwini Komarla

North Florida Division GME Research Day 2022

No abstract available.

Improving Inpatient Life Sustaining Treatment Documentation At Orlando Va Healthcare System, Patrick Abou Jaoude, Jomaris Centeno, Muhaimeen Hossain, Michael Stewart, Lahari Tumuluri, Jorge Restrepo, Palacios

North Florida Division GME Research Day 2022

No abstract available.

Improving Code Status Discussion And Documentation For Patients 65 Years Or Older At Hca Fl Osceola Hospital, Taylor Murphy, Mark Duros, Faris Matanes, Keishla Garcia Fernandez, Raj Shah, Olga Karasik

North Florida Division GME Research Day 2022

No abstract available.

A Quality Improvement Project To Increase Diabetic Retinopathy Screenings, Daniel Joh, Reema George, Brandi Addison

Gulf Coast Division GME Research Day 2022

No abstract provided.

Increasing The Rate Of Discharges Before 11 Am, Victoria Odeleye, Heather Mcgovern, Melissa Khalil, Rey Marrero, Musab Shouman, Zeeshan Zafar, Joshua Shultz

North Florida Division GME Research Day 2022

No abstract available.