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Table Of Contents: The Medicine Forum Volume 20, 2018-2019

The Medicine Forum

Clinical Images

Case Reports

Cardiology
Endocrinology
Gastroenterology and Hepatology
Hematology and Oncology
Infectious Disease
Pulmonary Medicine
Rheumatology

Original Article

Editorial

Literature Review

Creative Writing

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From The Editors, Colin Thomas, Md, Eitan Frankel, Md, Guy Katz, Md, Michael Weintraub, Md, Brianna Shinn, Md, Navdeep Sangha, Md, Rachel Redfield, Md, Mario Caldararo, Md

The Medicine Forum

We are delighted to present you with the 20th annual edition of The Medicine Forum. Here in the birthplace of our nation, we like to think of The Medicine Forum as being of the housestaff, by the housestaff and for the housestaff. Undeniably, this publication would not be possible without the countless hours dedicated by our residents, students, fellows and faculty.

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From The Desk Of The Residency Program Director, Emily Stewart, Md

The Medicine Forum

It has been another wonderful year in the Jefferson Internal Medicine Residency Program. Our program continues to train the best and brightest residents in the country. This publication is just one example of the passion, dedication and creativity our residents continue to provide to the Jefferson Community. The residents are not just outstanding clinicians but excel in all aspects of medicine including: research, humanities and medical education.

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Safe Care For Seizure Patients On An Epilepsy Monitoring Unit, Deborah Bachand, Lauri Wilson, Rachel Caiola, Lynne Keller, Megan Selvitelli, Mary Jo Farley, Jennifer O'Neill, Sara Shrock, Hannah Plummer, Sally Prokey, Amy Sparks, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Operations Transformation

Seizure patients admitted to an Epilepsy Monitoring Unit located within an academic tertiary medical center have a high potential to impact patient safety. As a result, a unit based team identified a need for a higher level of training for both their staff and float companions to ensure safe and standardized care for this group of patients.

The goal of this quality improvement project was to create an educational tool that would assist 100% of staff in better recognizing and responding to seizures. Baseline metrics and root cause analysis demonstrated a lack of consistent information being taught, a poorly identified …

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June 2019, Randy Curry, Cindy Brooks

RURAL ROCKS

Rural Rocks, the Rural Health Network newsletter by the SWOSU College of Pharmacy

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Patient And Student Experience On An Interprofessional Hotspotting Team, Steven Elsesser, Md, Elizabeth Feeney, Bsn, Katherine Petty, Spt, Kevin Shaloo, Spt, Nancy Tang, Pharmd

JCIPE Posters

The purpose of the Student Hotspotting initiative is to identify these individuals, understand their barriers and intervene by:

Connecting them with community resources
Improving coordination and communication between both providers and the patient
Empowering these individuals to better manage their health

Our patient (DW) lives in a close-knit, 4-generation household that just welcomed their newest member: a black-and-white kitten

DW is a 61 year-old female who recently received orthotopic heart transplant. Her comorbidities include sleep apnea, GERD, OA, chronic pain syndrome, COPD and a history of a CVA

We identified 3 main barriers to address with DW

Transportation difficulties
Management …

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Bridging The Gaps: Team 6 Hotspotting Experience, Sean O'Sullivan, Rebecca Schuck, Sean Tonnesen, Gabrielle Sallade, Emily Osisek, Avninder Ubhi

JCIPE Posters

Healthcare spending in the U.S. reached $3.5 trillion in 20171. Half of this spending was due to only 5% of patients. Hotspotting is the practice of identifying high-utilizing patients and providing them ancillary care. Supporting such patients with nutrition information, care coordination, clinician communication, health education, and treatment adherence coaching benefits the patients, clinicians, and healthcare system. The Jefferson Interprofessional Student Hotspotting Program places students of different educational programs into teams to identify high-utilizing patients and provide them individualized and holistic care. It is an intimate longitudinal clinical experience for students and an opportunity to improve the health of complex …

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Interprofessional Student Hotspotting: Impact Of Federally Qualified Health Centers (Fqhc) On Complex Patients, Alexis Amendola, Pallavi Chary, Andrew Day, Graziella Holland, Michelle Murray, Jesse Simpson

JCIPE Posters

Individuals with complex health and social needs drive much of the total cost of care, accounting for nearly 50% of annual costs. Studies show that patients’ use of community health centers is associated with lower health care costs, less frequent use of emergency departments, and fewer preventable hospitalizations, compared to patients who do not use the health centers. Federally qualified health centers (FQHCs) provide patients with medical homes where they can build ongoing, personal relationships with treatment teams, resulting in continuous, comprehensive and integrated care.

Additionally, addressing these individuals' needs and decreasing costs requires interprofessional teams to engage with communities …

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Interprofessional Student Hotspotting Learning Collaborative: A Student Initiative To Together Help Patients In Tangible And Intangible Ways, Kristin Brannon, Saskia Levy-Sheon, Michael Murphy, Megan Rankel, Caroline Christianson, Carly Alexander, Tejash Patel, Mariana Kuperman, Md, Leigh Ann Hewston, Pt, Dpt, Med, Ceeaa

JCIPE Posters

The Interprofessional Student Hotspotting Learning Collaborative brings together a team of students who work closely with individual patients with complex medical histories who are “super-utilizers” of health care resources.

Our goals:

Provide a targeted, patient-centered approach to patient care
Learn about our patient’s health from their perspective and develop a plan based on the patient’s goals and perceived needs
Minimize misuse and miscommunication that had previously hindered the patient healthcare experience.
Bring unique perspectives from each of our respective disciplines to improve upon inefficiencies in care
Our team consisted of students from the colleges of Occupational Therapy, Physical Therapy, Nursing, …

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Interprofessional Perspectives: Challenges & Lessons Learned From Participation In The Student Hotspotting Program, Alex Faus, Bs, Jennifer Newman, Ba, Stephanie Quist, Bm, John Ra, Bs, Madeline Runyen, Ba, Kelsie Wilhelm, Bsfs

JCIPE Posters

By participating in the Student Hotspotting Program, students learned that:

Coordinating the care of a complex patient requires an interprofessional team
Hotspotting interventions can often be complicated by uncontrollable circumstances
Building trust is key to working with patients who may be hesitant to engage with the healthcare system
Successful interprofessional healthcare teams are characterized by specific attributes
As future healthcare practitioners, we can apply these lessons into our own interprofessional interactions to optimize our treatment plans for complex patients

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An Overview And An Experience Of Hotspotting, Adam Myer, Allyson Psillos, Brianna Brown, Anne Bono, Stephen Kern, Phd, Otr/L, Faota, Jamie Smith, Michele Zawora, Md

JCIPE Posters

United States Healthcare Dilemma

In the United States, a large proportion of healthcare resources and costs are utilized by a small percentage of the population.

Approximately 25% of the United States healthcare costs are incurred by 1 percent of the population, while 5% are of healthcare costs are incurred by 50% of the population. The small percentage of the individuals who consume large amounts of resources has led to the term “super-utilizers.”
These patients usually have complex and hard-to-manage conditions, as well as socioeconomic barriers to care, which frequently lead to potentially avoidable emergency department and hospital admissions and complications. …

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Student Hotspotting: A Novel Dynamic For Learners And Patients, Richard Jeffries, Lydia Glick, Katherine O'Rourke, Mi Bui, Jennifer Morelli, Katherine Cambareri, Florencia Campbell, Miranda Aragon, Tracey Vause-Earland

JCIPE Posters

About the Student Hotspotting Program:

A team of interdisciplinary students working with patients with complex medical and social needs

Identify "super-utilizers" of the healthcare system

These patients frequently use the Emergency Department as primary source of medical care
A "super-utilizer" of the ED is costly to the patient and system

Goals:

Build relationships
Identify needs and goals
Provide support to navigate healthcare system and increase independence

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