Medical Specialties Commons^™

Decreasing Post Insulin Hypoglycemia Incidence In End Stage Renal Disease (Esrd) Patients, Anna Lo, Md, Rachana Mundada, Md, Eric Shiffrin, Md, Jenny Wang, Md

Health Equity and Quality Improvement (HEQI) Summit

ESRD patients are vulnerable to hypoglycemia due to impaired insulin clearance, glucose metabolism changes, and effects of dialysis. Hypoglycemic events lead to serious and life-threatening complications.

Aims for Improvement:

To decrease the rate of hypoglycemic events amongst ESRD patients receiving insulin for hyperkalemia treatment.

Outpatient Mineralocorticoid Receptor Antagonist Prescription Rate For Heart Failure, Svenja Schneider, Md, Sairamya Bodempudi, Md, Joshua Bernard, Md, Ryan D'Angelo, Pharmd, Eitan Frankel, Md, Sara Collins, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement:

Improve MRA prescription rate in the outpatient cardiology clinic by 25%

Medication Safety In The Operating Room, Tzvi Grossman, Michael Glick, Alexandra Mulholland, Febina Padiyath, Fred Balzer

Health Equity and Quality Improvement (HEQI) Summit

The operating room is an area where a significant number of adverse drug events occur. Anesthesia providers administer potentially dangerous medications with very little oversight. We looked for a way to decrease the likelihood that a lethal dose of phenylephrine (10mg) would be given to a patient.

Perioperative Outcomes Of A Hydrocortisone Protocol After Endonasal Surgery For Pituitary Adenoma Resection, Tyler D. Alexander, Ms, Sarah Collopy, Michael Karsy, Md, Phd, Msc, Chandala Chitguppi, Md, Christopher J. Farrell, Md, James J. Evans, Md

Health Equity and Quality Improvement (HEQI) Summit

Adrenal insufficiency after transsphenoidal resection of pituitary adenoma (PA) can be seen in 1-12% of cases. In PA, the use of postoperative cortisol measurement and supplementation remains controversial. It is unclear whether postoperative cortisol supplementation has a measurable effect on improving outcomes in patients with pituitary adenoma undergoing endoscopic transsphenoidal surgery (ETS). The objective of the study was to evaluate a postoperative steroid treatment protocol in patients with PA undergoing ETS.

Perioperative Vte Chemical Prophylaxis At Jefferson Hospital: A Retrospective Review Of The Department Of Surgery, Walker Lyons, Md, Matthew Metzinger, Mba, Cphq, Tyler Grenda, Md, Craig Binney, Mba, Scott Cowan, Md

Health Equity and Quality Improvement (HEQI) Summit

Only 26.1% of patients are receiving perioperative VTE chemical prophylaxis for elective cases in the Department of Surgery

Utilization Of A Palliative Care Trigger In The Surgical Intensive Care Unit, Gillian Love, Md, Shawn Mangan, Msn, Rnfa, Anp-Bc, Agacnp-Bc, Michelle Mckay, Phd, Rn, Ccrn, Joshua Marks, Md, Facs, John Liantonio, Md, Mba, Hmdc

Health Equity and Quality Improvement (HEQI) Summit

• Our project aims to expand palliative care availability in the SICU by implementing a consult trigger program.
• We also aim to learn about and measure compassion fatigue of providers within the SICU.

Reforming The Pre-Operative Clearance Process In The Covid-19 Era, Ritam Ghosh, Md, René Daniel, Md, Jesse Edwards, Md, Catriona Harrop, Md, Janeen Duckworth, Msn, Amy Della Penna, Msn

Health Equity and Quality Improvement (HEQI) Summit

The problem at hand was increasing cancellation rates, increasing frustration amongst physicians, and lack of communication which guided our interventions

Some of the interventions used to improve the process are:

• PAT practioners routinely checking laboratory tests after the initial visit
• PAT practioners routinely documenting addendums in medical record in order to improve transparency and medical record
• Two step verification process: residents/surgeons going through medical record and communicating to PAT practioners if clearance was not ironclad
• Consulting physicians (i.e. cardiologists) with improved communication and documentation with PAT practioners in the event of additional testing necessary prior to clearance
• PAT physicians communicate …

Improving Time To Defibrillation At Thomas Jefferson University Hospital, Sairamya Bodempudi, Md, Lisa Wus, Dnp, Rn, Crnp, Pccn-Cmc, Juergen Kloo, Md, Patrick Zeniecki, Ma, Frances Mae West, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Increase in timely defibrillation by 30% over 1 year
• Decrease in the amount of Vfib/VTach cardiac arrests that are not defibrillated to <1% within a 1 year time frame

Preventing Iatrogenic Pneumothorax “Just-In-Time”, Jason Ho, Md, Ammar Saati, Md, Ryan Commins, Md, Justin Henneman, Md, Frances Mae West, Md

Health Equity and Quality Improvement (HEQI) Summit

• In 2020 a high incidence of iatrogenic pneumothorax was noticed at TJUH after internal jugular central line insertion - Accepted rate is 0.1%
• With long periods of time between ICU rotations, residents suffer from significant procedural skill decay
• The COVID-19 pandemic brought with it an increase in the number of central lines placed
• During the COVID-19 pandemic, there has been a lack of large group training opportunities due to social distancing constraints

By December 31st 2021, our intervention will improve rates of iatrogenic pneumothorax after US-guided internal jugular central line insertion by 50% of baseline, as measured by chart review …

Mind The Gap: A Call For Attention At The Telemetry Station, N. Haroian, Md, T. Zivan, D. Frisch, A. Greenspon, Y. Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

"Gaps" in telemetry recordings are a risk factor for patient identification errors and have led to near misses and adverse events in our hospital.

Goal: Completely eliminate wrongful telemetry data display by the end of the academic year.

Team-Based Outreach To Improve Colorectal Cancer Screening Rates In An Urban Family Medicine Practice, Alexa Waters, Md, Olivia Seecof, Md, Graham Stratton, Md, Caitlyn Haines, Md, Brittany Hozick, Md, Jose Medina, Md, Kathryn Topalis, Md, Hannah Facey, Md, Chelsea Salas-Tam, Md, David Peters, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Aim to increase CRCS rates for our resident team patients by 5% by May, 2021
• Target Population (n=99): Age 50-74, due for CRCS, office visit within last 2 years, team resident listed as PCP, active on MyChart, and speak English

Adolescent And Young Adult Oncology Patient And Provider Perspectives In Philadelphia (Aya-4p), Christoher Terry, Md, Miriam Pomerantz, Lsw, Jodi Sandos, Lcsw, Lindsay Wilde, Md

Health Equity and Quality Improvement (HEQI) Summit

Primary Objectives

• To assess the current perspective of AYA patients regarding medical services and psychosocial support delivered to AYAs in Philadelphia
• To assess the current knowledge and perspective of healthcare providers at the SKCC about the care and services needed by AYA patients

Improving Practice Accessibility Through Mychart Utilization, G. Bires, M. Taskier, P. Padgaonkar, L. Flink, R. Wiley, S. Newsom, J. Mitchell, S. Cokenakes, J. Schutzman, A. Nwaobasi, T. Huang

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Increase patient portal MyChart activation for a cohort of approximately 2,000 patients at JFMA by 1% from February to April 2021.
• Demonstrate evidence of utilization including appointment scheduling, results review, and communication with providers through MyChart after activation.

Addressing Health Disparities And Access In The Department Of Neurology Outpatient Setting In The Era Of The Covid-19 Pandemic: A Quality Improvement Initiative, V. Wang, M. Rehman, K. Burda, L. Liao, M. Braslavsky, T. Chuang, J. Diep, Md, E. Isaac, E. Wong

Health Equity and Quality Improvement (HEQI) Summit

Neurology, a largely outpatient specialty, has joined many other fields in the endeavor of incorporating telemedicine.^4,6,7 We present the results of analysis of the Epic Electronic Medical Record (EMR) of all outpatient visits from the Thomas Jefferson University Hospital Department of Neurology from 2019 to 2020 in order to identify areas of ethnic minority and geographic disparities with regards to usage of telemedicine. For our analyses, we have included Neurology patients across the General Neurology (JUP Neurology 909 Walnut NEU), Headache Center (HA), and Multiple Sclerosis Center (MS). Additionally, based on patient surveys from a subset of our outpatient …

Improving The Use Of Asthma Action Plans, Pooja Pandit, Md, Aaron B. Kaye, Md, Hassan Shahid, Md, Colin Peters, Do, Jessica Most, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Identify the percentage of asthmatics in Friday fellows’ clinic with an AAP in place.
• Determine if clinician education can increase the number of AAP created for patients.

Addressing Catheter Associated Uti In The Neuro Icu, Aria Mahtabfar, Md, Giuliana Labella, Msn, Caitlin Harley, Msn, Omar Shah, Md, Mba

Health Equity and Quality Improvement (HEQI) Summit

Increasing systemic pressures have forced clinicians to identify and address a variety of metrics to provide better “quality” care. Catheter associated UTIs (CAUTI) are a common health careassociated infection in the Neuro ICU and are associated with increased LOS and overall mortality.

Aims for Improvement: Improving the incidence of CAUTI at the Gibbon and JHN ICUs on an annual basis after incremental interventions.

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 …

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 …