Medical Specialties Commons^™

Reducing Overnight Interruptions For Nonurgent Electrolyte Repletion, M. Duncan Kilpatrick, Md, Trishya Srinivasan, Md, Bertilia Tavarez, Md, Tatianna Branch, Do, Edwin Perez, Md, Zachary Pang, Md, Ryan Gardner, Md, Daniel Taupin, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Overnight patient interventions, including electrolyte repletion, contribute to hospital acquired delirium.¹
• Among patients admitted to TJUH, we identified many cases of IV magnesium (Mg) repletion given overnight, waking up patients when urgent repletion may not be clinically necessary.
• This may be driven by resident belief that IV Mg increases serum Mg more effectively than PO Mg
• TJUH has implemented the Electrolyte Hub in EPIC which standardizes the dosing and ordering of electrolytes in most cases.
• However, the default in most non urgent cases is to administer the first dose of electrolyte now, whether it is PO or IV. …

Improving Deep Vein Thrombosis Rates In Spine Surgery Patients, Arbaz A. Momin, Md, James Harrop, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

- DVT/PEs are sources of morbidity and mortality in hospitalized patients
- Spine surgery patients are immobile postop and tend to be obese
- For spine surgery patients DVT rates reported to range from 0.3% to 15.5%
- DVT propagation to PE can lead to significant mortality

• 30-day case fatality rate of PE is 3.9%

- Quality metric that hospitals are evaluated

• Patient safety indicator (PSI)

By The Book: A Look At Whether Guidelines Impact Clinical Decision Making In Sglt2i Prescriptions, Marc Mounzer, Vacha Shah, Antony Fuleihan, Brian Osler

Health Equity and Quality Improvement (HEQI) Summit

Introduction

• Specialty-specific guidelines reduce medical errors and support clinical decision- making
• Effective implementation requires timeliness and accuracy, often limited by systemic barriers
• This study investigates factors affecting sodium glucose cotransporter 2 inhibitor (SGLT2i) prescribing in heart failure to enhance guideline adherence and care quality

Inpatient Thrombophilia Workup After Acute Vte: The Tests That Don’T Pay It Forward, Eliakim Munda, Bs, Ruben Rhoades, Md, Ms

Health Equity and Quality Improvement (HEQI) Summit

Background

• Venous thromboembolism is a complex multifactorial disease that is influenced by genetic, environmental and behavioral risk factors.
• Testing for inherited thrombophilia is commonly performed after a VTE event to help identify underlying genetic risk factors and assess the risk of recurrence.
• Despite clinical guidelines advising against thrombophilia testing in patients with acute VTE, these tests continue to be ordered even though lab results are unlikely to alter treatment decisions

Problem Statement

• At TJUH, activity and genetic assays are frequently ordered for patients with acute VTE during admission, increasing the likelihood of false- positive results that may lead to unnecessary …

Optimizing Intraoperative Parathyroid Hormone Testing Protocols To Improve Efficiency And Outcomes In Parathyroid Surgeries, Andrew Neeson, Bs, Hani Samarah, Bs, Bryan Renslo, Md, Eric Fei, Ba, Kalena Liu, Bs, Harleen K. Sethi, Do, Elizabeth E. Cottrill, Md

Health Equity and Quality Improvement (HEQI) Summit

Background:

• Intraoperative PTH (ioPTH) helps confirm the removal of hyperfunctioning glands by leveraging its short half-life (~3-5 minutes).
• Timely results are critical for minimizing unnecessary bilateral neck exploration and operative time.
• Delays in ioPTH processing can increase anesthesia time, OR costs, and patient risk.
• Anecdotal reports have suggested variation in ioPTH processing speeds across Jefferson Health surgical sites.

Problem Statement: Significant delays in ioPTH turnaround time at one surgical site may prolong operative and anesthesia times, compromising patient safety.

Project Aim: To identify and compare ioPTH processing times across three surgical sites to pinpoint workflow inefficiencies and propose future improvements.

Dermatology Residency Education In Treatment Of Testosterone-Induced Acne Vulgaris And Androgenic Alopecia In Transmasculine Individuals: A Cross-Sectional Survey Of Academic Dermatologists, Thinh Q. Nguyen, Bs, Zachary J.K. Neubauer, Bs, Angela Zaldonis, Md, Sherry X. Yang, Md, Faad

Health Equity and Quality Improvement (HEQI) Summit

Background and Objective

• Testosterone-induced acne vulgaris (TiAV) and androgenic alopecia (TiAGA) are common dermatologic effects of gender- affirming hormone therapy (GAHT) in transmasculine or non- binary individuals, with prevalence estimates ranging from 31.1% to 88% for TiAV and up to 63.3% for TiAGA. These conditions can contribute to significant psychological distress and may exacerbate gender dysphoria, underscoring the importance of affirming, evidence-based dermatologic care.
• Despite increasing access to GAHT and the high prevalence of these conditions, there are no standardized guidelines for the management of TiAV and TiAGA, and data on dermatology trainees’ preparedness to care for this population are …

Association Of The G8 Screening Tool With Neoadjuvant Chemotherapy Outcomes In Older Adults With Urothelial Carcinoma, Kendall Ozorowski, Umma Fatema, Amman Bhasin, Julia Palecki, Michael Zimmerman, Kristine Swartz, Kevin Zarrabi, Kuang-Yi Wen

Health Equity and Quality Improvement (HEQI) Summit

Intro

• Urothelial carcinoma (UC) predominately affects older adults who often face increased adverse outcomes and reduced survival.
• Standard of care treatment entails neoadjuvant cisplatin- based chemotherapy followed by cystectomy with urinary diversion.
• The American Society of Clinical Oncology recommends older patients with cancer undergo Comprehensive Geriatric Assessment (CGA) prior to cancer treatment.
• The G8, a geriatric assessment tool, is a validated screening tool for identifying frailty requiring CG

Standardizing Icu-To-Ward Transitions: Implementing Icu-Pause In The Process Of Medical Intensive Care Unit Downgrade, Edwin Perez, Md, Benjamin Tasevac, Md, Timothy J. Kuchera, Md, Erika J. Yoo, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• The ICU-to-ward transition is a high-risk process in which unstandardized communication can increase the risk for adverse events.
• Variability exists in documentation content, quality, and even authorship.
• Aims:
  • Institute the standardized ICU-PAUSE framework for ICU downgrades
  • Reassign documentation responsibility to the sending rather than receiving team
  • Evaluate the impact of these interventions on provider satisfaction & understanding of patient care

Reducing Premedication Use With Intravenous Iron In The Outpatient Setting, Tara Rakiewicz, Liam Heneghan, Mark Attilio, Ruben Rhoades, Michael Zimmerman, Matthew Tucker, Brianna Costello, Adam Binder, Tanya Thomas

Health Equity and Quality Improvement (HEQI) Summit

Background

• Intravenous (IV) formulations of iron are safe, quick, easy to administer, and are indicated in patients with Iron Deficiency.
• Prior formulations of IV iron were associated with anaphylaxis and have since been removed from the market -- healthcare workers remain anxious about their potential for reactions
• Rate of anaphylactic reactions are about 1 in 200,000 infusions
• Current IV formulations available can be associated with a complement mediated, pseudo-allergy, that presents with flushing, myalgia/arthralgia, and chest pressure. Reactions are dependent on infusion rate and improve after stopping the infusion.
• Premedication with acetaminophen and diphenhydramine are often ordered for IV iron …

Time To Transfer - The Clock Is Ticking: A Quality Improvement Project, Tara Rakiewicz, Liam Heneghan, Brianna Costello, Matthew Tucker, Michael Zimmerman, Tanya Thomas, Jessica Sheridan, Adam Binder

Health Equity and Quality Improvement (HEQI) Summit

Background

• Thomas Jefferson University Hospital Center City (TJUH CC) campus is the predominant referral center for patients with hematologic malignancy in parts of PA, DE, and NJ
• Patients accepted for transfer to TJUH under Medical Oncology, often have longer than anticipated time to transfer (time from transfer acceptance to patient physical arrival)
• Long transfer times delay potentially lifesaving diagnostics and treatment; this can be most concerning for patients with aggressive hematologic malignancies given need for subspecialist management
• Data review from 2023-2024 showed patients with aggressive hematologic malignancy (defined as acute leukemia, chronic myeloid leukemia in blast crisis, diffuse large B …

Improving Recognition And Reporting Of Blood Transfusion Reactions In The Inpatient Setting, Tara Rakiewicz, Douglas Russ, Juliana Guarente, Katy Loos, Mary Harach, Jeffrey Riggio, Elizabeth Teixeira, Adam Binder

Health Equity and Quality Improvement (HEQI) Summit

Background

• Blood product transfusion reactions are associated with a spectrum of signs/ symptoms and can be challenging to identify. Transfusion reactions occur in about 1.1% of transfusions and constitute a significant source of iatrogenic morbidity and mortality.
• There is a nationwide under-reporting of transfusion reactions to blood transfusion Services.
• At TJUH, formally reported reactions comprised 0.24% of all blood product transfusions in 2024, similar to the national reporting average of 0.22%.
• Transfusion associated circulatory overload (TACO), and Transfusion related acute lung injury (TRALI) are two leading causes of mortality of blood transfusion reactions (Figure 1).
• Under-reporting leads to false data …

Are Hospital-Acquired Sepsis Cases Over-Reported Due To How Sepsis Is Coded In Electronic Health Records?, Michael Sakarya, Cooper Roslund, Spencer Foreman, David Gaieski, Md, Shruti Chandra, Md, Wayne Bond Lau

Health Equity and Quality Improvement (HEQI) Summit

Introduction

• Hospital-acquired sepsis (HAS) is a preventable cause of morbidity and mortality for hospitalized patients and is associated with greater cost and resource utilization compared to non-HAS.
• International Statistical Classification of Disease (ICD) coding system is used to identify HAS.
• Patients assigned HAS by ICD coding are presumed to have a nosocomial infection.
• Errors by ICD coding may cause misclassification of HAS cases.
• Unclear whether misclassified HAS have different outcomes than actual HAS

Single Center Comparison Of Home Sleep Apnea Testing Based On Respiratory Polygraphy Vs. Peripheral Arterial Tonometry, Stephen F. White, Md, Praneet C. Kaki, Bs, Henry C. Ideker, Md, Ritu G. Grewal, Md

Health Equity and Quality Improvement (HEQI) Summit

Introduction

• Home sleep apnea testing (HSAT) is an accessible option for diagnosing obstructive sleep apnea (OSA) in patients with high pre- test probability of moderate to severe OSA
• Cardio-respiratory polygraphy (RP) has traditionally been utilized and involves wearing a nasal airflow cannula, pulse oximeter, and respiratory effort belt with actigraphy
• Peripheral arterial tonometry (PAT)-based testing is a newer technology that involves wearing a disposable smartwatch-sized computer on the wrist, sensor on the finger and sensor on the chest and has been validated for HSAT
• PAT-based HSAT has been increasingly utilized due to perceived ease of use, improved patient comfort, and …

Interpreting Difficult Conversations In The Virtual World - Interpreter’S Perspective, Joyce Zhang, Bs, Kaitlyn Williams, Ms, Kathleen Mechler, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Medical Interpreters are essential in language discordant patient-family-team interactions
  • Facilitate clear communication
  • Aid in understanding diagnosis, prognosis, and treatment options
• Prior studies highlight range in interpreter comfort with serious illness conversations (SIC) though limited to in-person interpreter experience
• Rise of quick-access virtual interpreter services across the nation in many healthcare setting

Ensuring Timely Interventional Radiology Biopsy Procedures With Standardized Pre-Procedural Protocol And Guidelines, Joy Zhao, Md, Mohsin Arsiwala, Md, Minki Hong, Md, John Scalise, Md, Limi Jamma, Md, Hanna S. Ellingsen, Md

Health Equity and Quality Improvement (HEQI) Summit

Proposal

• Aim
  • To decrease rate of canceled or delayed IR biopsy procedures by 25% by implementing pre-operative order sets for inpatient IR procedures at Jefferson Center City Hospital in the next 6 months 
• Population of Interest
  • Jefferson Center City teaching team patients requiring IR biopsies
• Intervention
  • Implementing pre-operative order sets that include diet restrictions, anticoagulation guidelines, pre-operative labs, and pre-operative blood pressure and glucose goals 
• Quantifiable Outcome Measurement
  • Comparing rates of canceled and/or delayed IR biopsy procedures in the patient group that use the pre-operative order set compared to those who did not use the order set 
• Data Collection Methods …

Safe Paralytic Reversal For Neurologic Examinations, Keenan Piper, Md

Health Equity and Quality Improvement (HEQI) Summit

AIM Statement

Institute a protocol for safe administration of sugammadex to obtain neurologic exams with a goal of 90% adherence and three or less agitation-related complications over a 6-month period

Improving Viral Hepatitis Testing With A Clinical Scenario Based Order Set: The Viral Hepatitis Hub, Jordan Feingold-Link, Md, Elizabeth A. Braden, Md, Courtney E. Comar, Phd, Jonathan M. Fenkel, Md, Kory S. London, Md, Sean P. Moss, Md, Elizabeth Novick, Md, Matthew Pettengill, Phd, Christine Papastamelos, Md, Jeffrey M. Riggio, Md, Daniel Taupin, Md

Health Equity and Quality Improvement (HEQI) Summit

Background and Problem

Viral hepatitis disproportionately affects historically marginalized populations, with less than one-third of high-risk patients receiving appropriate screening. Racial and ethnic minoritized groups, rural residents, and PWID face significant disparities in both testing and treatment.

Paradoxically, while underserved populations remain undertested, providers frequently order inappropriate hepatitis tests, particularly acute- phase markers like HAV IgM and HBV core IgM, in clinical situations where guidelines do not indicate their use. This pattern of inappropriate testing is partly driven by provider uncertainty regarding the selection of appropriate serologic tests from a complex array of options. Clinical decision support (CDS) within computerized …

Enhancing Diabetes Management With Visual Tools: A Multimodal Approach For High-Risk Urban Populations, Mikyla R. Futz, Jesse Edwards, Md, Fhm

Health Equity and Quality Improvement (HEQI) Summit

Background & Objective

Patients from historically marginalized communities face disproportionate barriers to diabetes mellitus (DM) management due to limited health literacy, language discordance, and a lack of culturally responsive educational resources. These structural challenges contribute to poorer glycemic control, higher complication rates, and reduced adherence to recommended care. While visual communication tools have demonstrated efficacy in improving comprehension, self-efficacy, and disease outcomes in chronic illness, their integration into diabetes care remains limited and inconsistently implemented.

Visual interventions may be particularly impactful in populations with low health literacy or limited digital access, yet few have been embedded into routine outpatient workflows. …

Enhancing Primary Care Navigation For D/Deaf And Hard-Of-Hearing Patients: A Wayfinding Intervention Proposal, Mikyla R. Futz, Mary L. Micou, Robert S. Pugliese, Pharmd, Bcps, Jesse Edwards, Md, Fhm

Health Equity and Quality Improvement (HEQI) Summit

Background

Auditory-dependent healthcare environments present persistent barriers to patients who are d/Deaf or hard of hearing (d/DHH), particularly where verbal instructions and auditory notifications dominate communication workflows. This contributes to delayed access to care, decreased satisfaction and strained patient provider-relationships, and significantly higher hospitalization rates —16-21% for individuals with mild to moderate hearing loss, respectively. Additionally, these patients experience higher rates of chronic conditions, lower health literacy, and reduced healthcare satisfaction. Existing interventions are often fragmented and narrowly focused, failing to capture the heterogeneity of d/DHH patients’ needs. This project introduces a scalable, continuous solution grounded in inclusive design principles …

The Need For Innovative Changes In The Jackson-Pratt (Jp) Drain, Elizabeth Goldstein, Bs, Spencer Haber, Krishna Koka, Bs, Devin Williams, Bs, Andrew Newman, Md

Health Equity and Quality Improvement (HEQI) Summit

Purpose

The JP drain is a closed suction drain used in surgeries throughout the body. This design, introduced by Dr. Frederick Jackson and Dr. Richard Pratt in 1971, prevents seroma formation through continual negative pressure drainage while resisting drain collapse and obstruction. Through a focused literature review, we summarized findings on JP drain-related complications in breast reconstruction and mastectomy. Though the JP drain effectively reduces seroma formation, there has been a profound lack of innovation in how its design addresses Surgical Site Infection (SSI), Surgical Site Pain (SSP), and Quality of Life (QOL). In addition, there is no standardized, evidence-based …

Social Vulnerability And Health-Related Social Need Disparities Amongst Young Adults With Breast Cancer, Steven Manobianco, Md, Julia Palecki, Md, Alexis Bennett, Md, Fatoumata Diaby, Ms, Rebecca Cammy, Lcsw, Emmanuel Worede-Kal, Scott Keith, Phd, Maysa Abu-Khalaf, Md, Mba, Maria Hafez, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

- Breast cancer is the most common non-cutaneous malignancy affecting women in the United States, with a lifetime incidence of nearly 13%

- The incidence of female breast cancer is rising, especially for young women (age < 45)

- While only 5-10% of breast cancers in the general population are related to highly penetrant pathogenic germline mutations, pathogenic mutations in BRCA1, BRCA2, CHEK2, PALB2, BARD1, and ATM occur at higher frequency in women diagnosed age < 50 years

• Mutations in BRCA1, BRCA2, and TP53 account for nearly 50% of breast cancers diagnosed before age 30

- Women < 40 years old breast cancer have worse disease-related survival, especially from to early-stage disease

Checklists To Improve Emergency Medicine Resident Confidence In Airway Management, Tiara Paul, Bs, Elizabeth Glowacki, Md, Sean Mcgann, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Determine the level of confidence regarding airway management among TJUH emergency medicine residents
• Implement education based on identifiable knowledge gaps
• Assess for improvement in resident confidence and discover avenues to optimize the education program

Resumption Of Anti-Platelet/Anticoagulation Therapy Following Lumbar Spine Surgery, Stephanie Serva, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Problem: There is data on AC/AP use in perioperative period for patients undergoing spine surgery and no formal established guidelines on when to resume AC/AP medications after surgery
• Aim: To determine standardized protocol for resuming antiplatelet/anticoagulation therapy following lumbar surgery and to reduce combined post-operative cardiac/cerebrovascular/thrombotic events, and post- operative hematomas by 10% in 5 years
• Population: Patients undergoing elective lumbar spine surgery who take AC/AP at home

Oncology Infusion Center Hyperglycemia Protocol, Gunjan Umarji, Md, Eric J. Shiffrin, Md, Rose Dimarco, Pharmd, Bcps, Bcop, Emily Brand, Pharmd, Daniel Lin, Md, Ashley Miles, Msn, Rn, Helen Evers-Hunt, Msn, Anp-Bc, Ocn, Claudia Thomas-Nembhard, Msn, Rn

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem: Patients receiving chemotherapy may find it challenging to get care in a timely fashion if they develop diabetes or dysglycemia while receiving chemotherapy. Preliminary research indicates that dysglycemia may reduce the effectiveness of chemotherapy.

Aim: To initiate a protocol to ensure adequate euglycemia in patients at the Oncology Infusion Center (OIC) to eliminate insulin treatment guesswork and create a pathway that is least disruptive to the timing of patients' chemotherapy regimens.

Improving The Quality Of Internal Medicine Discharge Summaries Via Accurate Admission Medication Reconciliation, Natasa Kostic, Md, Tammy Tran, Md, Kenneth Meserole, Md, Jon Zaid, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Transitions of care are a time of vulnerability for patients.
• Nearly 20% of patients experience an adverse event within 3 weeks of hospital discharge, with adverse drug events being the most common.
• Discharge (DC) summaries serve to provide safe transition of care by describing hospital course and medication changes for review by outpatient providers.
• At TJUH, DC summaries are completed by internal medicine (IM) senior residents, but there is variability in quality of hospital course and thoroughness of medication reconciliation.
• Inaccurate admission medication reconciliation may lead to inaccurate reporting of discharge medication lists, causing confusion for both patients and …

Readmission For Picc Line Placement In Spine Surgery, Joseph Schaefer, Md, Joshua Heller, Md, James Harrop, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Pseudoarthrosis is failure of adequate bony fusion after a spinal fusion
• Prior literature has implicated occult C. acnes infection in cases of pseudoarthrosis
• Intraoperative cultures are often sent in cases of pseudoarthrosis at Jefferson
• C. acnes cultures often result after discharge requiring readmission

Medical Assistance In Dying In A Profit-Driven Health System: Ethical And Equity Challenges In The U.S. Vs. Canada, Joseph A. Zwillenberg, Eric M. Teichner, Jacob Schwell, Cameron Haghshenas, Joseph F. Majdan, Md, Facp, Fcpp

Health Equity and Quality Improvement (HEQI) Summit

Introduction

Medical Assistance in Dying (MAID), legalized in Canada in 2016, now accounts for 4.1% of all deaths nationwide and 6.6% in Quebec as of 2022(1). In Canada’s single-payer system, MAID is integrated as a publicly funded medical service. In contrast, the U.S.’s fragmented, market-driven system is defined by profit maximization, inequitable access, and insurer- driven decision-making. While MAID aims to promote autonomy and compassion, introducing it into the American context raises profound ethical concerns, particularly regarding nonmaleficence and systemic coercion. This poster evaluates the unique risks MAID poses within the U.S. healthcare system, particularly for vulnerable populations.

Instituting A New Traumatic Ich Algorithm At Jefferson, Michael Baldassari, Md, Matthews Lan, Md, Caitlin Ritz, Md, Tyler Alexander, Bs, Richard Schmidt, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Traumatic brain injury (TBI) is a high-incidence condition causing substantial economic burden on trauma centers worldwide. Many institutions have begun using validated algorithms for safe management, such as the Modified Brain Injury Guidelines (BIG) Criteria. At Jefferson, tICH have not historically been treated algorithmically, and therefore, tICH patients are often subject to excessive imaging surveillance and admission lengths.

Aim Statement: To institute a new algorithm modeled off mBIG criteria for the management of tICH patient at Jefferson to streamline treatment and safely reduce the number of surveillance HCTs obtained, as well as length of stay in this …

Incorporation Of The 4ms, With A Focus On Mentation, Into The H&P For Older Adults Hospitalized With A Hip Fracture And Its Effect On Delirium Documentation, Emily Custer, Do, Kristine Swartz, Md, Lily Ackermann, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Delirium affects 15% to over 50% of patients with hip fractures during their hospital stay (1) and is associated with increased mortality, increased length of hospital stay, poorer functional outcomes, and higher risk of nursing home placement (1,2). However, at Thomas Jefferson University Hospital, the prevalence of documented delirium post-hip fracture is only 5.22%, suggesting potential under recognition. Additionally, at the end of 2025, a new CMS inpatient quality metric will require public reporting on a hospital's capability to provide age-appropriate care for older adults, which can be done by utilizing the 4M framework of age-friendly health care. The …

Deprescribing Type 2 Diabetes Mellitus Medications In Older Adults In An Urban Primary Care Setting, Katelyn Koons, Md, Eugenie Hughes, Md, Eunice Choe, Md, Julio Garcia, Md, Munifa King, Md, Emily Lavell, Md, Michael Danielewicz, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Adults 65+ take on average five medications daily
• Polypharmacy increases risks of drug interactions and adverse events
• About 29% adults 65+ in developed countries have type 2 diabetes mellitus (T2DM) and the number of older adults living with these conditions is expected to increase rapidly in the coming decades
• Over-treatment of DM in older adults is common and increases risks of serios adverse outcomes including hypoglycemia
• Older adults with T2DM should have higher A1c goal consistent with ADA guidelines: [See Table on Poster]