Daniel Altman, MD; Solomon R. Dawson, MD; Kevin Kwak, MD; Drew Johnson, MD; Harshal Mehdi, MD; and Christie Mulholland, MD
At Thomas Jefferson University Hospital (TJUH), there has been a perceived necessity among housestaff and fellows to routinely check and replete serum potassium and magnesium for inpatients prior to endoscopic procedures In addition, there was an unwritten policy that these electrolytes needed to be aggressively repleted, with a goal potassium above 4.0 and magnesium above 2.0 Contributing factors include absence of clear policy, fear of adverse outcomes during procedures, and fear of delay of procedures leading to increased hospital stay This practice has led to unwarranted lab draws, costs of lab tests and electrolyte riders, and possible delayed procedures
- Clarify policies regarding electrolyte repletion
- Determine frequency of inappropriate electrolyte checking and repletion Determine monetary cost of this action
- Decrease frequency of inappropriate electrolyte lab check and repletion
Justine Blum, MD; Christopher McGrath, MD; Anita Modi, MD; Shivam Saxena, MD; Ashish Shah, MD; Nimrita Sidhu, MD; and David Oxman, MD
Our project goals are to:
a) assess the burden of unnecessary PICCs and other non-tunneled central lines on med-surg units at TJUH and
b) understand the underlying reasons behind the problem. In the first phase of our project we conducted an audit of med-surg unit PICCs and other non-tunneled central lines with the goal of obtaining a rough estimate of the number of line days that are unnecessary.
By December 31, 2017, the TJUH medical-surgical floors will reduce the number of unnecessary PICC lines by 30%.
A Quality Improvement Project to Reduce the Wait Time for Initial Appointment in an Urban Outpatient Sleep Center
Anasua Chakraborty, MD and Ritu G. Grewal, MD
In this study we aimed to see if replacing one face to face follow up visit after sleep study with a phone call by a trained office staff will
- decrease the total number of follow up office visits, thus decreasing health care cost
- increase the number of new patients seen during the 6 month follow up period
- Did not decrease patient compliance
Poster presented at annual House Staff Quality Improvement and Patient Safety poster session.
Debbie Chen, MD and Gretchen A. Diemer, MD
To determine why and when general medicine non-ICU patients are upgraded from a non-telemetry level of care to telemetry monitoring at Thomas Jefferson University Hospital (TJUH). Comparison of the reasons for initiation of continuous ECG monitoring with the AHA and ACC guidelines would provide a greater understanding of the applicability of these recommendations to non-ICU general medicine patients. This information can provide guidance to identify areas of intervention to decrease inappropriate and/or overutilization of telemetry. The ultimate goal is to identify general medicine patients who are likely to benefit from continuous ECG monitoring, without negatively affecting clinical outcomes for those who do not receive cardiac monitoring.
Debbie Chen, MD; Megan Margiotta, MD; and Grant Turner, MD
Through an Interprofessional Root Cause Analysis of this Near Miss event, we aimed to: 1.Identify issues contributing to the incorrect dosing of acyclovir 2.Understand relevant institutional policies and compare this to usual practice 3.Propose possible solutions
Patrick G. Connors, MD and Bracken Babula, MD
By using a sequence of two distinct interventions, we aim to improve the rate of medication reconciliation at Jefferson Internal Medicine Assoc.
Helping to Support CPC+ Initiative to Integrate Behavioral Health Within Primary Care: A Team-Based Approach to Improving Depression Management
Daniel J. Devine, MD; Jesse Edwards, MD; Sarah E. Rosenberg, MD; Bracken Babula, MD; Jason Ojeda, MD; Lawrence D. Ward, MD, MPH, FACP; and Barry S. Ziring, MD
The objective of this project is to increase the rate of documented successful treatment of depression for both new and established diagnoses of depression at Jefferson Internal Medicine Associates (JIMA) from 29% to 50% over 12 months.
Lost in Translation: A Standardized, Interdepartmental Approach to Improve the Safety of Inpatient Transitions of Care
Allison Greco, MD; Andrew Brown, MD; Kristin Lohr, MD; Bracken Babula, MD; and Rebecca C. Jaffe, MD
During the 2016-2017 academic year physician perception of favorability regarding inpatient interunit handoffs will meet the national HSOPS benchmark without negatively impacting patient bed flow.
All ACGME training programs at Thomas Jefferson University Hospital will expose their new trainees to standardized handoff training during orientation in June 2017 as well as adapt a framework for monitoring trainee compliance and proficiency.
Stephen Huelskamp, MD; Juergen Kloo, MD; Christine Giordano, MD; Amit Vira, MD; Albert Lee, MD; John Caruso, MD; and Barbara S. Knight, MD
Smart AIM: Improve hypertension control with the following goal: Within three months 60% of patients with hypertension will have a blood pressure less than 140/90 during their most recent office visit.
"The Weekend Effect": Weekday versus Weekend comparison of patients admitted with NSTEMI in terms of length of hospital stay, door to balloon time and left ventricular function
Wajahat Humayun, MD; Ali Raza Ghani, MD; Asoka Balaratna, MD; and Mary Naglak, PhD
The primary objective of our study was to determine the difference in the outcome, if any, between patients presenting with NSTEMI on weekends versus weekdays. We also looked for the difference in clinical outcomes between these two groups of patients.
Poster presented at annual House Staff Quality Improvement and Patient Safety Posters.
Obstacles and Challenges to Implementing Multi-departmental QI at a Large, Academic Training Center-Lessons Learned from a HCV Screening Program
Eric M. Kasprowicz, MD, MPH; S. Arastu, MD; Silpa Yalamanchili, MD; Amy Javia, MD; Madalene Zale, MD; Priya Mammen, MD, MPH; and Jonathan M. Fenkel, MD
We aimed to double the HCV screening rate of ‘baby-boomers’ admitted to the medicine teaching service at Methodist Hospital over the course of 6 months and demonstrate improved linkage to care for HCV RNA+ individuals.
Initial efforts were a collaboration between Emergency Medicine, where faculty had experience implementing an HIV screening program, and Gastroenterology, a key stakeholder in linkage to care. Our pilot period coincided with new state regulations mandating that hospitals implement HCV screening for inpatients. These new regulations dramatically altered the scope and goals of the project.
Kemarut Laothamatas, MD; Linda Yan, MD; Daniel Kramer, MD; and Matthew Enriquez, MD
To improve the pneumococcal vaccination initiation rates in patients 65 years and older in Jefferson Hospital Ambulatory Practice (JHAP) to the institutional quality measure goal of 80% over a 4 month period from January to May of 2017.
Patient Attitudes Toward a Physician Led Radiology Review: Improved Understanding of Medical Conditions and a Potential New Quality Metric
Jessica A. Latona, MD; Sami S. Tannouri, MD; Theresa P. Yeo, PhD; Shawnna Cannaday, CRNP; Harish Lavu, MD; and Jordan M. Winter, MD
We were interested in understanding patient perspectives regarding the importance of reviewing their imaging studies with a surgeon.
1. What value do patients place on viewing their imaging?
2. Do patients have a better understanding of their disease and planned operation after a surgeon led review of imaging studies?
3. Do patients find viewing images an accessible educational tool?
Newton Mei, MD; Grace Yang, MD; Mital Shah, MD; and Albert Lee, MD
Our aim at Wednesday JHAP was to increase the rate of colorectal cancer screenings from 44.3% to 60% from September 2016 to May 2017 (9 months)
Rino Sato, MD; Matthew Murphy, MD; Margaret Ivanov, MD; Alan Gandler, MD; Roshni S. Patel, PharmD, BCPS; John Caruso, MD; Loren Chen, MD; and Albert Lee, MD
Within 6 months, we aim to decrease by 10% the number of our diabetic patients with an A1c >8 through Clinical Pharmacist referrals.
Jinyu Zhang, MD; Maria Vershvovsky, MD; Noha Ghusson, MD; Jeffrey Riggio, MD; and Lily Ackermann, MD
With a more formalized discharge instruction evaluation process for PGY-1s, discharge instructions for specific diagnoses will have less error in a year’s time.
Neha Agarwal, MD and Tasha Kouvatsos, MD
To increase the number of diabetic patients that are ordered a diabetic diet at time of admission
So that blood sugars may be better controlled throughout admission with decreased usage of CDI
Barriers to Anticoagulation in Atrial Fibrillation among Cardiologists, Internists and Family Physicians
Jad Al Danaf, MD, MPH; Mitul Kanzaria, MD; and John U. Doherty, MD
The rates of AC in patients 18 years or older who visited general internists & family physicians not seen by cardiologists from 4/30/2013 to 4/30/2015, cardiologists from 11/29/2012 to 11/29/2014 and all 3 specialties from 1/30/2014 to 1/30/2016 were derived from the EHR.
A 12-question survey was shared using RedCap with these physicians to examine potential reasons for not prescribing AC.
Medical Student and Resident Foley Catheterization training program to decrease Post-Operative Catheter Associated Urinary Tract Infections
Peter J. Altshuler; Adam P. Johnson, MD, MPH; Danica Giugliano, MD; Gerald A. Isenberg, MD; and Scott W. Cowan, MD
Determine whether a more comprehensive medical student urinary catherer training curriculum can be successful in decreasing post-operative CAUTI rates in general and vascular surgery patient populations.
Reduce post-operative UTI rates by 0.5% over 6 months
Achieve 100% medical student confidence in Foley catheter placement, understanding indications and contraindications to urinary catheterization.
Improve objective performance of urinary catheterization skills as determined by objective clinical skills exam (OSCE) scores.
Improving Influenza Vaccination Rates and Understanding Reasons for Patient Refusal at Jefferson Hospital Ambulatory Practice
Daniel Brandt, MD; Ashley Butland, MD; Kevin Kwak, MD; Joseph Yoo, MD; Albert Lee, MD; and Susan West, MD
Improve influenza vaccination rates for eligible patients at the Jefferson Hospital Ambulatory Practice to levels above the national average of 43.6% between October 2015 and March 2016 with universal screening and improved documentation.
To characterize reasons for patients who did not receive vaccination.
On-Site Test Collection Intervention Improves Lead Screening Rates at an Urban Family Medicine Practice
Krys Foster, MD, MPH; Tina Castellan, MD; Kelly Lopez, MD, PGY-III; Phoebe Askie, MD, MPH; Daniel Chung, MD; Laura Parente, MD; Yury Parra, MD PGY2; Grace Amadi, MD; Mariana R. Kuperman, MD, MPH; Bruce Reaves, MD; and Marc Altshuler, MD
Examine the effect of on-site lead screening collection on resulted lead screening rates.
Anusha G. Govinda, MD; Anita Modi, MD; Emma Biegacki; and Bryan Hess, MD
Performance measure: Percentage of HIV-infected patients with documentation of influenza vaccination in Allscripts.
Numerator: Number of HIV-infected patients who have obtained an influenza vaccine during influenza season.
Denominator: Total number of HIV-infected patients at the Jefferson Infectious Disease (ID) Clinic
Patient exclusions: Those who are allergic to eggs or have had allergic reactions to the influenza vaccine in the past
Goal: "75% of HIV-infected patients at the Jefferson ID clinic will be vaccinated against influenza and documented in Allscripts during influenza season"
Allison Greco, MD; René Daniel, MD; Raymond Janowski, MD; and Bracken Babula, MD
Goal for Improvement:
To improve proper medication regimens for patients as they transition between healthcare settings
So that patients achieve improved outcomes and reduced hospital admissions caused by medication errors
SMART aim is to decrease teh number of discrepancies between discharge medication lists and pill bottles or blister packs produced at one-week follow up with Jefferson PCP by 10% within six months.
Analyzing Patient Satisfaction and Improved Physician-Patient Communication Using Introductory Brochures
Raza A. Hasan, MD and Lily Ackermann, MD
Assess how the use of introductory brochures added to patient satisfaction at time of discharge. Also, assess whether the brochure helped foster improved physician-patient communication.
Justin Herman, MD; Andrew Dargan, MD; John Madara, MD; Michael Baram, MD; and Bharat K. Awsare, M.D., FCCP
For patients admitted to the medical ICU over an additional period of 17 months, our goal is to reduce the rate of ICU readmissions within 72 hours of transfer out of the ICU to less than 2%. This will as a result reduce the costs of care, length of stay, and in-hospital mortality rates for these patients.