House Staff Quality Improvement and Patient Safety Conference (2016-2019)

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  Central Line Cart: An Emergency Department Initiative to Improve Efficiency

  M. Ahmed, MD

  Background

  • Critically ill patients that present to the emergency room often require time sensitive resuscitative measures, which often necessitates placement of a central venous catheter.
  • Efficient placement of a central venous catheter is often limited by the time it takes to gather the number of supplies needed for the task.
  • It is already known that central venous catheter procedure carts and kits decrease the incidence of central line associated bloodstream infections (CLABSIs)1 as well as reduce the incidence of procedural mistakes during central line insertion2
  • However, there is a paucity of data in regards to the impact of central line procedure carts on the efficiency of central line insertion.
  • The objective of this study was to assess whether a pre-stocked central line cart would reduce the time it takes to place the catheter in critically ill patients in the emergency room.

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  The ‘med history note’: A standardized method of reducing medication history errors among internal medicine residents in a teaching hospital

  Odunayo Banjoko, MD; Babatunde Ogunnaike, MD; Genene Amoia-Pigliacelli, PharmD; and Doron Schneider, MD

  Problem Statement

  According to the institute of medicine’s preventing medication errors report, the average hospitalized patient is subject to at least one medication error per day. Errors have been known to occur during admission, transfer and discharge of patients. An accurate medication history on admission is crucial and can go a long way in preventing medication reconciliation errors. Of note, more than 40% of medication errors occur from inadequate reconciliation, during admission, transfer and discharge of patients. Of these, 20% result in harm.

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  Implementation of Attending-Supervised IPASS Handoff in the Neuro-ICU

  Laura Cifrese, MD; Sonia Gill, MD; Megan Margiotta, MD; Muhammad Athar, MD; Rodney Bell, MD; Sara Hefton, MD; Fred Rincon, MD, MSc, MBE; Syed Shah, MD, MBA; Jacqueline Urtecho, MD; Matthew Vibbert, MD; David Wyler, MD; and Amandeep Dolla, MD

  Background

  • Duty hour restrictions, cross coverage, and the growing number of mid-level practitioners has led to an increased number of handoffs across medical specialties
  • These handoffs are well-known points of communication breakdown which can lead to patient safety issues
  • Factors contributing to an effective handoff include standardization of communication, appropriate training and supervision, ample time, a quiet environment, and a supportive culture
  • We hypothesize that attending supervision of handoffs is feasible and can improve practitioner perception of transitions of care

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  Implementation of a Volunteer-Based Hospital Program for Older Adults

  Elizabeth Collins, MD and Kristine Swartz, MD

  Background

  • A multi-faceted, volunteer-led, hospital-based program1has been shown to: •Reduce the incidence of delirium •Decrease hospital length of stay •Reduce hospital costs.
  • Implementation of such a program requires upfront investment.
  • A smaller, volunteer-based visitation program for older adults may provide support for the allocation of more hospital resources in delirium prevention and establishment of a formal Hospital Elder Life Program1in this institution.
  • This research aims to investigate: •If the implementation of a visitation program is feasible at this hospital •Volunteer experience with the program.

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  Improvement in Patient Safety through “Irrigation Time-Outs” During TURP Procedures

  B. L. Deiling, DO; E. Kilmartin, MD; and T. L. Kennedy, MD

  Objective

  During any surgical procedure, clear and standardized communication among surgeons, anesthesiologists and operating room nursing staff is a necessity for all aspects of patient safety. During TURP procedures, the perioperative staff must alert team members of the signs and predictors for the potential of TURP syndrome or NSS overload. The goal of our quality improvement project is to increase communication and diagnostic actions based on irrigation fluid amounts among surgeons, anesthesiologists, and the operating room nurses in order to decrease complications in TURP patients at Jefferson over the next six months.

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  Prevention and screening of VTE in SCI patients at Thomas Jefferson University Hospital

  Erika Dillard, MD, PhD; Yusef Mosley, MD; Joshua Marks, MD; Christina Jacovides, MD; Geoffrey Ouma, MD; and James Harrop, MD

  Currently no protocol exists for thromboprophylaxis (TPx) and screening in SCI patients at TJUH. As such, often patients are either not started on TPx or are started on an inappropriate regimen depending on admitting team preference. In addition, patients often receive an admission DUS then weekly thereafter as a screening mechanism for DVT even if asymptomatic.

  Our goal is to determine the effectiveness of our current method for initiating pharmacological TPx as well as efficacy and cost of our current screening method compared to national guidelines by addressing these questions:

  • What is the occurrence of VTE in SCI patients at TJUH?
  • What screening tools are utilized (clinical exam, DUS)?
  • How often is recommended LMWH initiated? Does this vary with care team?
  • Is TPx initiated within 72h and, if not, why (ie, anticipated surgery, bleeding risk, intracranial hemorrhage)?
  • How often are SCI patients screened? How often are clinically insignificant DVTs diagnosed?
  • What are the costs associated with the current screening method at TJUH?

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  Adequate patient education - The key to improving patient experience while being under contact precautions?

  Edosio Eloho, MD; Mary Naglak, PhD; Doron Schneider, MD; Hadiatou Barry, MD; Babatunde Ogunnaike, MD; Puneet Dhillon, MD; and Neethu Gopisetti, MD

  Objectives

  To improve patient satisfaction with the quality of education provided about CP by at least 30% by the end of 7 months. Through the provision of a standardized patient education sheet to hospitalized patients placed on CP within their first 24 hours being placed under contact isolation.

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  Order from Order Sets: Analysis of Ordering Patterns and Patient Outcomes Before and After Order Set Changes on the Inpatient Psychiatry Units at TJUH

  David Halpern, MD

  Aims

  Short Term

  To decrease the total number of times one-time orders were added for patients for Vistaril, Remeron, Melatonin, Colace, Senna, and MiraLAX. Increase number of times urine PCP and urine oxycodone added to the urine drug screen.

  Long Term

  To decrease overall length of stay and improve treatment outcomes

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  Optimizing Physical Therapy Sessions Among Patients Undergoing Elective Lumbar Surgery

  Ellina Hattar, MD; Kelly Hufford, DPT; Marie Wilson, RN; and James Harrop

  Background

  Physical therapy is imperative in achieving early mobilization, thereby reducing morbidity of immobility such as venous thrombolic events, improving postoperative pain, and facilitating appropriate disposition among patients who have recently undergone spine surgery. At TJUH, patients undergoing elective spine surgery are planned to engage in physical therapy (PT) twice a day. There are however several impediments that may limit the ability of patients to adequately participate in PT.

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  Standardized Discharge Instructions and their Impact on Post Operative Patient Knowledge

  Nikolaus Hjelm, MD; Gregory Epps, MD; Ryan Rimmer, MD; Lauren Bogdan, MD; and Erin Reilly, MD

  After every surgery, surgeons send their patients home with discharge instructions. The information is intended to educate the patients about their postoperative care and how to safely care for themselves upon returning home. Each surgeon reviews and approves the discharge instructions before they are given to their patients. This information is once again reviewed by the patient’s nurse before the patient leaves the hospital.

  Within a large hospital, there are often several surgeons within each specialty that perform the same surgeries. The department of Otolaryngology at Thomas Jefferson University Hospital is no exception. Within otolaryngology there are several subspecialties. At Jefferson’s University campus hospital, these subspecialties consist of rhinology, otology, head and neck, plastics, and laryngology. Currently there are three rhinologists, two otologists, six head and neck surgeons, three plastic surgeons, and three laryngologists.

  Within the department, there has been a movement towards standardizing discharge instructions for every subspecialty. The belief is that if every surgeon that performs the same operation comes to an agreement with postoperative care, there will be less confusion among the nurses and residents who are often the first-line medical staff responsible for answering patient questions. Among the subspecialties within our department and institution, some have already standardized their discharge instructions while some have not.

  As residents, we answer home call questions from patients from 5pm to 8am every weekday and at all times over the weekends. It was our goal to determine if patients who received standardized postoperative discharge instructions had less postoperative questions over these time periods than those patients who had not. This would allow us to reflect on our care of patients in the postoperative setting and see if patients were more educated about their care if they received standardized postoperative instructions.

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  Adaptation of a Standardized Handoff System for a Radiology Residency Program

  Riti Kanesa-thasan, MD; Liya Gendler, MD; Megan Margiotta, MD; Kristin Lohr, MD; Grant Turner, MD; Rebecca C. Jaffe, MD; Christopher G. Roth, MD; and Suzanne Long, MD

  Background/Objectives:

  • The Joint Commission has linked communication failure as a root cause for a majority of sentinel events.
  • The “I-PASS” system is a hand-off mnemonic that has been shown to decrease medical errors, prevent adverse events, and improve communication.
  • Multiple Jefferson residency programs have adopted I-PASS training over the last year to standardize sign-outs between treatment teams and departments.
  • Radiology residents also participate in hand-offs with other departments, especially in cases of adverse patient reactions that occur within radiology (ie: allergic reaction, seizure, contrast extravasation). In addition, radiology residents also participate in hand offs between daytime and overnight teams, including sign out of pertinent protocols, studies, and clinician communications.
  • The aim of this study was to assess the adaptability of I-PASS training to the needs of a diagnostic radiology residency program.

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  Improving follow-up for family medicine patients after hospital discharge

  Erica Li, MD; Rebecca Simon, MD; Michael Weissberger, MD; Angela Silverman, MD, MPG; Bryan Botti, MD; Laura Emerson, MD; Zoe Agoos, MD; Rachel Ehrman-Dupre, MD; Jennifer Moyer, MD; Andrew Rabovsky, MD; and Geoffrey Mills, MD, PhD

  Aims

  • Increase percentage of JFMA patients with follow-up appointment scheduled after discharge to 100% by March 2018
  • Increase percentage of JFMA patients who show up to their follow up appointments after discharge to 80% by March 2018

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  Improving Resident Confidence and Efficiency During Stroke Alerts Through Simulation Training

  Megan Margiotta, MD; Danielle Wilhour, MD; Elan Miller, MD; Robin D'Ambrosio, BSN, SCRN; Maria Carissa Pineda, MD; Fred Rincon, MD; Rodney Bell, MD; and Diana Tzeng, MD

  Objectives

  • Teach incoming neurology residents how to respond efficiently and appropriately to stroke alerts
  • Improve the confidence level of residents during stroke alerts

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  The effects of office-based interventions to increase patient enrollment in an online electronic medical record portal

  Lionel McIntosh, MD; Allison Rague, MD; Claire Thesing, MD; Amy Lachewitz, MD; Gillian Love, MD; Daniel Sizemore, MD; Zachary Klock, MD; Aimee McMullin, MD; Zeynep Uzumcu, MD; and Patrick McManus, MD

  We aimed to increase the number of JFMA patients signed up with MyChart by 50% over a 5 month time frame by educating providers and staff on ways to implement patient portal sign up into the office visit as well raising awareness of the portal for both providers and patients

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  Establishing Cost-effective Management of Postoperative Urinary Retention after Spine Surgery

  Nikolaos Mouchtouris, MD; Catriona Harrop, MD; Edward Kloniecke, MD; Victoria English, CRNP; David Wyler, MD; Kamini Patel, RN, MBA; Ashwini Sharan, MD; and James Harrop, MD

  Goal

  Our goal is to develop evidence-based guidelines that:

  1. streamline the order/timing of interventions in patients who develop PUR after spine surgery
  2. identify those at high-risk of long-term urinary retention that require further workup
  3. minimize the rate of PUR –goal is to reduce to 3.5% in FY 2019
  4. and determine the cost savings from our intervention when applied to all surgeries

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  A Provider-Based Survey on Quality of Care and Identification of Quality Gaps in Inpatient Palliative Care

  Adam Pennarola, MD, MPH; Matthew Murphy, MD; Elizabeth Collins, MD; Beth Wagner, MSN, CRNP, ACHPN; and John Liantonio, MD

  Background

  Inpatient Palliative Care Teams (IPCTs) are often called upon to provide multidisciplinary care across hospital settings at Jefferson. However, there is currently no mechanism in place wherein providers consulting the IPCT can provide feedback to specialty palliative care clinicians. Such input from providers could be used to elucidate those services provided by the team which are most appreciated and those which require further development in order to be truly effective. Furthermore, such input may also serve to identify completely new areas for inpatient palliative care needs.

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  Hey, What’s the Delay? An Evaluation of Reporting Time for Pediatric EEGs

  Aparna Polavarapu, MD; Rachit Patil, MD; and Maromi Nei, MD

  Aim

  To determine if there is a reduction in time to EEG reporting after institution of the Pediatric Epilepsy fellowship track.

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  Process Improvement for Endovascular Thrombectomy in Patients Presenting with Acute Ischemic Stroke

  Richard F. Schmidt, MD; Michael J. Lang, MD; Robin Dharia, MD; Fred Rincon, MD; Thomas Zdanowski, RN, MSN; Robin D'Ambrosio, RN, MSN; Stavropoula Tjoumakaris, MD; M. Reid Gooch, MD; Pascal Jabbour, MD; and Nabeel Herial, MD

  Aims

  1. Critically evaluate the existing stroke activation and ET protocols for compliance with new 2018 metrics and guidelines.
  2. Review DTP times under the existing protocol to assess for potential inefficiencies or gaps in care delivery, specifically addressing differences between processes at JHN compared to ED/Gibbon.
  3. Make changes to the existing stroke alert protocol to better reflect current guidelines, streamline care, and ultimately improve process metrics (DTP times).
  4. Establish a system for recursive continuous analysis of AIS patients to identify protocol gaps, inefficiencies and areas for further intervention.

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  Improving Medical and Endovascular Management for Acute Ischemic Stroke Through Multidisciplinary Education and Simulation

  Richard F. Schmidt, MD; Megan Margiotta, MD; Elan Miller, MD; Robin D'Ambrosio, BSN, SCRN; Robin Dharia, MD; Maria Aini, MD; Diana Tzeng, MD; Fred Rincon, MD; Pascal Jabbour, MD; and Nabeel Herial, MD

  Primary goals:

  1. Reduce door to treatment times (both DTN and DTP) to meet and exceed existing guidelines metrics.
  2. Educate residents about acute stroke management, including national guidelines and new institutional protocols to improve efficiency during stroke alerts.

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  Improving Advanced Care Planning Documentation in the Outpatient Setting

  Carly Sedlock, MD; Tatiana Bekker, MD; Tara Sunder, MD; Mario Caldararo, MD; Divya Chalikonda, MD; and Newton Mei, MD

  Aims

  We aimed to increase Jefferson Hospital Ambulatory Practice (JHAP) electronic medical record documentation of advanced care planning discussion of 209 identified “high risk” patients via independently labeled ACP notes by 5% (from 1.4% to 6.4%) over a six-month period (October 1, 2017- April 1, 2018).9 We elected to focus this pilot project on high risk patients due to time constraints of the study period and we felt that these high risk patients would likely derive the most benefit from ACP planning in the outpatient setting.

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  Effective Hepatitis C Screening In High Risk Populations

  Aekata Shah, DO and Jennifer Seymour, DO

  Purpose

  The purpose of our study was to demonstrate how various quality improvement initiatives activated in selected Jefferson Northeast family medicine teaching offices have enabled effective HCV screening. Given the cost effectiveness of screening and early treatment versus treatment of the disease in the later stages of progression,8 we hope to encourage other primary care offices to implement quality initiatives to encourage appropriate HCV screening. This is especially important for the baby boomer generation, as well as for high risk individuals with a history for and/or current IV drug abuse or other high risk behaviors.

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  Get With the Rhythm – Telemetry Education in Internal Medicine Residency

  Rashesh Shah, MD; Hanna Sofie Ellingsen, MD; Molly Halloran, MD; Reetu Mukherji, MD; Juergen Kloo, MD; and Yair Lev, MD

  Aim

  • Our aim was to design and implement cardiac monitoring education for medical residents in order to help residents feel more comfortable navigating and assessing telemetry.
  • Our objective was to create and pilot a telemetry education video among Internal Medicine residents (from March to May 2018) resulting in a 75% increase in ability to demonstrate essential telemetry skills as determined by a pre and post video assessment.

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  Improving Transitions of Care for Inpatients with an eGFR < 20ml/min

  Brianna Shinn, MD; Brandon Menachem, MD; Robert Park, MD; Sarah Houtmann, MD; Zachary Lee, MD; Thomas Holden, MD; Tomoyuki Hongo, MD; Vincent Yeung, MD; Goni Katz-Greenberg, MD; and Peter Burke, DO, MBA

  In this study we conducted an analysis of 22 inpatients with an eGFR<20 that revealed there was a greater prevalence of patients without permanent AV access for HD initiation when compared to national data. These findings demonstrated the need for improved transitions of care and timely creation of AV access for this patient>population, thus we sought to improve this. This is the first inpatient initiative that our group is aware with the aim of improving timely AV access and transitions of care for an inpatient population (Figure 1).

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  Bad Out of the Box: A Report on Pre-operative Failure Rates of Reusable Flexible Ureteroscopes at a Single Institution

  Whitney R. Smith, Brian P. Calio, Scott G. Hubosky, Kelly A. Healy, and Demetrius H. Bagley

  Purpose: Single-use flexible ureteroscopes offer the advantage of being consistently functional and perfect for immediate clinical use right “out of the box.” Cost is the barrier to widespread acceptance of these instruments. Economic models have been put forth which compare the expense of acquiring and maintaining reusable flexible ureteroscopes to that of using single-use flexible ureteroscopes.However, one poorly defined variable in these models is the frequency of encountering an unsuitable reusable flexible ureteroscope at the beginning of a case. We sought to define this in a consecutive series of patients undergoing flexible ureteroscopy.

  Patients and Methods: Prospective analysis of all consecutive cases requiring flexible ureteroscopy over three months was undertaken. A combination of fiberoptic and digital flexible ureteroscopes comprised the available inventory. Per protocol, these instruments were grossly cleaned in the endourology suite after use, and sent to central processing for final cleaning, sterilization (STERRAD) and packaging. Repairs were managed by a third party repair service when needed. Ureteroscopes were defined as acceptable if they provided reasonable visualization, deflection, an open working channel that would accept passage of instruments and no evidence of gross contamination or overt damage/deformity.

  Results: Of 228 consecutive cases, a total of 261 reusable flexible ureteroscopes were unwrapped and 93 (90%) cases were initiated with the first instrument opened. In 11 (9.0%) cases, the initial ureteroscope opened was unacceptable for use and required opening an additional ureteroscope(s). In 7 cases, at least 2 instruments were opened. Also, 3,4, and 5 instruments needed to be opened in 1 case each. One case had to be rescheduled after 4 consecutive instruments were opened and all were unsuitable. Of 17 unfit instruments, 19 problems were noted and included broken deflection (4), dried cleaning solution on the instrument tip (4), inability to pass a laser fiber through the working channel (5), digital camera dislodged from distal bending rubber (2), crushed proximal shaft (1), digital image failure (1), lens trouble causing optical failure (1) and a missing sterilization cap (1). Considering all 119 instruments opened, 17 (14%) were unsuitable for immediate use.

  Conclusions: In up to 12.6% of cases, the initially opened reusable flexible ureteroscope is not fit for initiation of the procedure. This rate may vary among institutions depending on repair, processing, and nursing practices but represents one area where single use devices can fill an essential and immediate role.

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  Awareness During an Intensive Care Unit Procedure: A Root Cause Analysis and Creation of the D5 Handoff Tool

  Elise Strickler, DO and Bryan Lutman, DO

  Objectives

  The objectives of this study are to:

  1. perform root cause analysis of the systemic causes of an incident of awareness that occurred during bedside EGD and
  2. create a handoff tool that is easily remembered that conveys the essential information about ICU intubations.

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  The Use of Online CBT-I at Jefferson Sleep Disorder Clinic: A Quality Improvement Study

  Kathy Tran, DO and Ritu Grewal, MD

  Objectives

  We propose to introduce online CBT-I into our patient practice by distributing flyers to patients who complain of insomnia. We have made flyers available in all the exam rooms and educated physicians, nurse practitioners and staff. We will then review charts after the intervention period to evaluate for an increase in recommendation for CBT-I as a treatment option and education for patients.

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  Handoff Training in Undergraduate Medical Education – Identifying and Closing the Gaps

  Gregory Troutman; Jeffery Head; Andrew Day; John Hafycz; Lauren E. Grunenwald; Kelly Daniels; Kevin He; Rebecca Montana; and Alexis Wickersham, MD

  Objectives:

  • Our study sought to assess differences in perceptions and the use of standardized handoff tools between medical students near completion of their third and fourth years of medical school at Sidney Kimmel Medical College.
  • We hope to use this information to create targeted medical education interventions to better expose pre-clinical medical students to standardized handoff tools in the first and second years of medical school, before entering the wards.

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  Utilizing feedback as a mechanism to improve resident event reporting rates

  Grant Turner, MD; Kristin Lohr, MD; Ben Jones Jr., MD; Emma Lundsmith, MD; Megan Margiotta, MD; Riti Kanesa-thasan, MD; Bracken Babula, MD; and Rebecca C. Jaffe, MD

  Objectives

  • Provide feedback to 100% of residents entering a report between December 2017 and March 2018
  • Evaluate the degree to which residents value the feedback we were able to provide
  • Assess a pilot process for sustainability on a larger scale

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  Cross-Departmental Educational Program on Complex Airway and Epistaxis Management

  Adam Vasconcellos, MD; Meghan Crawley, MD; Michael Topf, MD; Ryan Gerritsen, MD; Dominick Gadaleta, MD; and Joseph Spiegel, MD

  Internists, emergency medicine physicians, and intensivists routinely provide essential care for patients with complex airways (i.e. tracheostomy and laryngectomy) and patients with epistaxis. Any of these physicians may serve as first responder in a complex airway or epistaxis emergency situation. Therefore, a basic understanding of complex airway and epistaxis management is essential. The otolaryngology department aims to provide our colleagues with fundamental take-home points to improve crossdepartmental care of these patients.

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  A video-based educational intervention for providers regarding colorectal cancer screening

  Zoe Agoos, MD; Bryan Botti, MD; Laura Emerson, MD; Angela Silverman, MD, MPH; Lori Atkinson, MD; Danielle Dang, MD, MPH; Elizabeth Collins, MD; Erica Li, MD; Rebecca Simon, MD; Michael Weissberger, MD; and Geoffrey Mills, MD, PhD

  Methods:

  Email sent to providers asking them to complete a 7 question survey regarding knowledge and self-reported comfort in screening for colorectal cancer using a shared decision-making approach.

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  It's Midnight. Do you know how your patient is doing?

  W. Alswalmeen, MD; K. Foley, MD; K. Noonan, MD; and R. Josloff, MD

  Transitions of care are vulnerable points in patient care. With the volume of information transferred, quality of care and patient safety are at risk. Numerous attempts at standardization of transitions of care have been utilized; however no consensus regarding the optimal method has been reached. We developed a “watcher” model in addition to standard end of shift sign out. Patients at risk were identified by the day team and seen overnight by a senior and junior surgery resident, along with a nursing representative: either a bedside RN or nursing supervisor. We hypothesized that these midnight rounds could proactively identify patient care issues and intervention would be implemented sooner in a patient’s hospital course

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  Inappropriate electrolyte repletion for patients undergoing endoscopic procedures

  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

  Goals

  • 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

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  Improving Blood Donor Diversity Through Focused Recruitment Interventions

  Sarah Amanullah; Vandi Ly, MD; Amanda Pirilli, MD; and Julie Karp, MD

  Study Design:

  Beginning in May 2016, the Jefferson Blood Donor Center began collecting donor self-identified race/ethnicity: White, Black or African American, Hispanic, Asian or Pacific Islander, American Indian or Alaskan Native, Multiracial, Other, Unknown (Figure 1).

  We retrospectively quantified the racial/ethnic groups represented in each month’s donor population.

  In January 2017,the following intervention strategies were implemented:

  Emailing donors who self-identified as part of a racial/ethnic minority group

  Contacting racially/ethnically-focused student groups to organize blood drives with the Jefferson Blood Donor Center

  Partnering with the Jefferson Medical Oncology Society MarrowthonDrive to encourage blood donations

  Presentation to the local chapter of the National Association of Hispanic Nurses

  Interventions still to come

  Featuring the Jefferson Blood Donor Center in the Office of Diversity and Inclusion’s Diversity Newsletter

  The quantification of racial/ethnic groups were stratified to pre-intervention months and post-intervention months.

  Poster presented at Thomas Jefferson University Hospital Housestaff Quality Improvement and Patient Safety conference.

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  Improving Resulted Hemoglobin A1c Rates: A Feasibility Study for Point-of-Care Hemoglobin A1c Testing at an Urban Family Medicine Office

  Phoebe Askie, MD, MPH; Daniel Chung, MD; Laura Parente, MD; Yury Parra, MD; Grace Amadi, MD; Mariana R. Kuperman, MD, MPH; Bruce Reaves, MD; Miranda Aragon, MD; Kyle Bardet, MD; Sunny Lai, MD; Anna Woods, MD; and Marc Altshuler, MD

  Study Aims:

  • Our practice’s goal is to increase the number of up to date hemoglobin A1c for diabetic patients seen at JFMA in order to help improve glycemic control
  • The aim of this study is to see if point of care (POC) hemoglobin A1C is a feasible way to increase the number of up to date hemoglobin A1C. We looked at various factors including timing, training, and flow.

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  Use of Standardized Patient Scenarios to Train Medical Assistants in an Ambulatory Rehabilitation Medicine Clinic

  Lawrence Asprec, MD; Ashley DePadua, MD; Sarah Durante, MD; Nicholas Freedman, DO; Andy Olsen, DO; and H. Kelly O' Donnell, DO

  Objectives:

  To improve the efficiency of our outpatient Rehabilitation Medicine clinic without sacrificing high value/quality patient care.

  To clarify the responsibilities of the MA and identify areas of redundancy in the rooming process.

  To demonstrate the utility of in-situ simulation for MA training.

  To reduce the time it takes for MAs to complete all assigned tasks to 10 minutes or less per encounter in at least 50% of patient encounters within two months from the time of intervention.

  To potentially highlight other areas in which to improve clinic efficiency and overall patient satisfaction (e.g. front desk registration process, resident and attending physician encounters, clinic and exam room accessibility).

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  Standardization of Monofilament use in a Resident-Run Clinic

  Odunayo Banjoko, MD and Doron Schneider, MD

  Study Aim:

  The aim of this study was to improve incidence of regular foot exams among clinic diabetic patients.

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  Maintaining Continuity in a resident run clinic-Impact of the 6+2 Scheduling.

  Odunayo Banjoko, MD; Doron Schneider, MD; and Rachel Ramirez, MD

  Objective:

  The aim of this study was to evaluate the continuity of care with regards to follow up with the same team (and optimally same resident) 1 year prior to implementing the 6+2 scheduling block and 1 year post schedule block change.

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  Quantifying Patient Reported and Documented Compliance with Adjuncts to Venous Thromboembolism Prophylaxis

  Tyler M. Bauer, MD; Katerina Dukleska, MD; Adam P. Johnson, MD, MPH; Johanna Beck; Myles Dworkin; Kamini D. Patel, RN; Geno J Merli, MD; and Scott W. Cowan, MD

  Objectives:

  1. Measure patient compliance with pharmacologic, mechanical and ambulatory prophylactic measures.

  2. Evaluate for agreement between nursing documentation and patient reported compliance with mechanical and ambulatory prophylactic measures.

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  Preventing Isolated Perioperative Reintubation: Who is at highest risk?

  Tyler M. Bauer, MD; Adam P. Johnson, MD; Chris Wirtalla, MD; Jordan E. Goldhammer, MD; Rachel R. Kelz, MD; and Scott W. Cowan, MD

  Objectives:

  1. We aim to characterize IPR nationally through a retrospective review of the National Surgical Quality Improvement Program participant user file (NSQIP PUF).

  2.Identify risk factors for IPR including analysis of procedure type and preoperative characteristics.

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  Beat to Beat: Implementing a Tailored Literature Review e-Newsletter for a Multidisciplinary Subspecialty Group

  Shashank Behere, MD and Steven Ritz, MD

  Objective:

  To increase availability and exposure to recent, relevant, reliable literature from a range of sources, for a multidisciplinary cardiac center, by creating an e-newsletter summarizing articles of interest.

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  Assessing the Burden of Unnecessary Central Venous Catheters in Patients on Medical-Surgical Floors

  Justine Blum, MD; Christopher McGrath, MD; Anita Modi, MD; Shivam Saxena, MD; Ashish Shah, MD; Nimrita Sidhu, MD; and David Oxman, MD

  Project goals:

  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.

  SMART AIM

  By December 31, 2017, the TJUH medical-surgical floors will reduce the number of unnecessary PICC lines by 30%.

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  Shedding Light on the Off-Hours Coverage Gap in Radiology: Improving Turnaround Times and Critical Results Reporting

  Gilda Boroumand, MD; Jaydev K. Dave, PhD, MS; and Christopher G. Roth, MD, MS-HQS

  Objective:

  Devise a plan to optimize off-hours faculty and trainee staffing within the Department of Radiology

  Measure the magnitude of patient safety gains in terms of report turnaround times (TAT) and critical results communication times (CRC)

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  Risk Factor Analysis for 30-Day Readmission Rates of Newly Tracheostomized Children

  Jenna Briddel, MD; Abigail Strang, MD; Jessica Levi, MD; Patrick Barth, MD; Aaron Chidekel, MD; and Udayan Shah, MD

  Objectives:

  Pediatric patients undergo tracheostomy for a variety of reasons; however, medical complexity is common among these patients. Although tracheostomy may help to facilitate discharge, these patients may be at increased risk for hospital readmission. The purpose of this study was to evaluate our institutional rate of 30-day readmission for patients discharged with new tracheostomies and to identify risk factors associated with readmission.

  Study Design:

  A retrospective cohort study was conducted for all pediatric patients ages 0-18 years with new tracheostomies at our institution over a 36-month period.

  Methods:

  A chart review was performed for all newly tracheostomizedchildren from 2013 to 2016. We investigated documented readmissions within 30 days of discharge, reasons for readmission, demographic variables including age and ethnicity, initial discharge disposition, co-morbidities, and socioeconomic status estimated by mean household income by parental zip code.

  Results:

  45 patients were discharged during the study time period. A total of 13 (28.9%) required readmission within 30 days of discharge. Among these 13 patients, the majority (61.5%) were readmitted for lower airway concerns, many (30.8%) were admitted for reasons unrelated to tracheostomy or respiratory concerns, and only one patient (7.7%) was readmitted for a reason related to tracheostomy itself (tracheostomalbreakdown). Age, ethnicity, discharge disposition, co-morbidities, and socioeconomic status were not associated with differences in readmission rates. Patients readmitted within 30 days had a higher number of admissions within the first year.

  Conclusion:

  Pediatric patients with new tracheostomies are at high risk for readmission after discharge from initial hospitalization. The readmissions are most likely secondary to underlying medical complexity rather than issues related specifically to the tracheostomy procedure.

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  Quiet in the Operating Room! Team STEPPS and OR Distractions

  Zabecca S. Brinson, MD; Adam P. Johnson, MD, MPH; Rose Farmer, RN; Tesa Leonard, CRNA; Susan Cacciatore, RN; Maritza Sanchez, RN; Lorie Weikel, RN; Paul Sammut, RN; and Francesco Palazzo, MD

  Background and Objective:

  From the moment that a patient enters the operating room to the time that they are brought to the post anesthesia care unit, a distraction has the potential to lead to an adverse outcome for the patient. During the critical portions of the surgery, it is even more important for all members of the operating staff to be focused and engaging in safe practices. Distractions in the operating room can hinder safe communication and potentially endanger patient safety. Team training has been shown to both improve team communication and reduce distractions.

  The objective of this project was using Team STEPPS training to reduce distractions during the critical portions of surgery, defined as the time of anesthesia induction, the time out, and the time of emergence from anesthesia

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  Implementation of a Standardized Handoff System for a General Surgery Residency Program

  E. M. Caparosa, A. M. Brown, J. Stern, G. Chevrollier, V. M. Kucherov, S. G. Woodward, and S. W. Cowan

  Introduction:

  The I-PASS Handoff Bundle is an evidence based standardized set of educational materials designed to decrease handoff failures in patient care.

  Two of every three "sentinel events", the most serious events reported to the Joint Commission, are due to failures of communication, including miscommunication during patient care handoffs.

  Implementation of the I-PASS method results in decreased medical errors and preventable adverse events

  There are few studies that evaluate this validated method in the context of a General Surgery resident program

  We aim to implement the I-PASS system into the transition of care process for General Surgery residents at our institution, and to analyze of the quality of the handoff process before and after the implementation.

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  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

  Project Aim:

  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.

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  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

  Project aim:

  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 Thomas Jefferson University Hospital House Staff Quality Improvement and Patient Safety conference.

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  The Use of Telemetry Monitoring Among General Medicine Patients

  Debbie Chen, MD and Gretchen A. Diemer, MD

  Objective:

  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.

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  The Case of the 10 Pound Giant: A Near Miss Root Cause Analysis

  Debbie Chen, MD; Megan Margiotta, MD; and Grant Turner, MD

  Objectives:

  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

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  Improving Medication Reconciliation Using Provider Education and an EHR Hard Stop

  Patrick G. Connors, MD and Bracken Babula, MD

  AIM:

  By using a sequence of two distinct interventions, we aim to improve the rate of medication reconciliation at Jefferson Internal Medicine Assoc.