House Staff Quality Improvement and Patient Safety Conference posters from 2020 can be found here.
Natalie Cosgrove, MD; Andrew Dargan, MD; Raja K. Dhanekula, MD; Gloria Francis, MD; Komal Gandhi, MD; Andrew Kistler, MD; Mark Malamood, MD; Bolin Niu, MD; Sheela S. Reddy, MD; Apeksha Shah, MD; Christina Tofani, MD; Andrew Zabolotsky, MD; Robert Cohen, MD; Stephanie M. Moleski, MD; and Jorge Prieto, MD
To improve patient prep compliance, prep quality, and an overall better experience by designing a prep specific website that will address the most common prep questions and concerns
Once launched, the website address will be placed on printed colonoscopy prep instructions and stated on the after hours GI clinic voicemail as an additional patient resource
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.
How good are we at determining risk? Quantifying the accuracy of clinician determined risk for VTE prophylaxis
Katerina Dukleska, MD; Adam P. Johnson, MD, MPH; Tyler M. Bauer; Myles Dworkin; Johanna Beck; Kamini D. Patel, RN; Geno J. Merli, MD; and Scott W. Cowan, MD
Create and validate a simple tool for concurrent audits of risk stratification, compliance and documentation
Evaluate accuracy of clinician risk stratification and prophylatic ordering practice compared with a standardized Caprini RAM across different assigned risk categories
Provide recommendations for EPIC VTE Prophylaxis CDS Development
Eloho Edosio, MD
The data collecting tool was a questionnaire that consisted of 11 questions structured to measure satisfaction with the quality of education provided before CP was implemented and also to evaluate overall satisfaction with the quality of health care provided by the hospital. A trial run was performed before it was administered to patients in the study group. The study group consisted of patients on CP from April till May 2017.
Laura Felder, MD; Amanda Paternostro, MD; and Johanna Quist-Nelson, MD
Objectives: To reduce the rate of postoperative endometritis in patients undergoing cesarean delivery by implementing a new departmental guideline for vaginal preparation prior to cesarean sections, after labor or rupture of membranes
Ali Raza Ghani, MD; Irfan Ahsan, MD; Wajahat Humayun, MD; Usman Sarwar, MD; Margot I. Boigon, MD; and Mary Maglak, PhD
Methods: We did a retrospective chart review of 138 patients admitted to observation floor with diagnosis of syncope.
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.
Matthew Grzywinski and Vandy Ly, MD
Our goal is to educate house staff on the indications for irradiated blood products. We hope to reduce the number of inappropriate irradiation orders to less than 50% of the total orders for irradiated blood products and to be followed up over time.
Utilization of a multimodal preoperative pain regimen prior to gynecologic oncology exploratory laparotomies
Lauren C. Hand, MD; Alison Vogell, MD; Talia Maas, MD; Kristina Masi, MD; Rebecca J. Mercier MD MPH; Norman G. Rosenblum, MD, PhD; and Christine H. Kim, MD
The aim of this study was to evaluate the use of a combination of non-opioid preoperative pain medications including Tylenol, Lyrica, and Celecoxib (TLC) in patients undergoing gynecologic oncologic exploratory laparotomies. We evaluated postoperative narcotic use in morphine equvalents (ME) as well as pain scores, anti-emetic use, and length of stay.
Transrectal Ultrasound Guided Prostate Biopsy Antibiotic Prophylaxis: Standard vs. Augmented Antibiotic Regimens, and the Role for Pre-Biopsy Rectal Swab Cultures
Thomas Hardacker, MD, MBA; Danielle Squadrito, RN; Christopher Caputo, MD; and Mark Mann, MD
To evaluate peri-procedural antibiotic prophylaxis regimens based on pre-procedural rectal swab cultures.
To evaluate infection rates between transrectalbiopsy patients receiving FQs alone and those receiving ceftriaxone or gentamicin in addition to FQs.
Paniz Heidari, DO; William Wieczorek, MD; Jayassree Iyer, MD; Denise Pineda-Fortin, MD; and Elizabeth Liveright, MD
With this newly instituted mandate, we found that many of the resident did not have access to the PDMP query site. Our initial goal is to have 100% of residents have log-in access to the PDMP site. Our long-term goals involve increasing the query of the PDMP website by OB-GYN residents prior to prescribing narcotic pain medication.
There are several changes that we can make to result in improvement of our initial goal including: identifying residents that require access, working with program coordinator to identify gaps in their PDMP application, and assisting in providing DOH with any additional documentation necessary for access.
We will measure our improvement with a survey of residents as to their ability to access the PDMP website prior to our intervention and afterwards. After the intervention we wish to survey the residents on their use and utilization of the Pennsylvania Department of Health Drug Prescription Drug Monitoring Program
Standardized Consent Forms for Surgical Procedures: An Intervention to Improve the Resident-led Informed Consent Process
C. Hodge, N. Sich, T. Olszewski, A. Rogers, R. Josloff, and K. Noonan
Objectives and Goals:
To provide high quality, consistent consent forms for common surgical procedures and improve resident workflow by creating and implementing standardized printed consents for common surgical procedures.
These consents will be used by residents consenting patients in the ED or inpatient setting.
Consents shall include standardized procedure descriptions, risks and benefits of the procedure, and alternative treatment option descriptions, risks and benefits
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.
Colin Huntley, MD
We conducted a retrospective chart review of patients in the Jefferson Sleep Disorder Center (JSDC) consisting of 2 cohorts of patients. The first was a group of patients undergoing PSG in March, 2014 prior to institution of the UAS program. The second was a cohort of patients undergoing PSG in July 2016 after institution of the UAS program, positive initial results, readily available literature in the JSDC, and a physician in-service including details of the procedure and outcome, quality of life, and complication rate data.
We collected demographic and PSG data. We then reviewed the electronic medical record and assessed the first and second followupat the JSDC for CPAP compliance data and referral for oral appliance, body positioning device, or surgical evaluation.
Geetha Jagannathan, MBBS and Jerald Z. Gong, MD
To consolidate the test performed at 2 different locations at 1, thereby improving cost effectiveness while maintaining quality and result turnaround time.
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, MPH; 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.
Addressing Barriers to Breast Cancer Screening: Where to Intervene to Increase Mammogram Completion Rates
Jennifer LaPorta, MD; Robert J. McClowry, MD; Elizabeth "Mackie" Talley, MD; Lionel McIntosh, MD; Allison Rague, MD; Claire Thesing, MD; Amy Leshner, MD; Gillian Love, MD; Daniel Sizemore, MD; and Patrick McManus, MD
Study sought to determine if an intervention would aid in increasing mammogram screening rates in the Jefferson Family Medicine Associates practice.
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?
Kristin Lohr, MD; Grant Turner, MD; and Allison Greco, MD
Handoffs between providers have increased following the implementation of the 2011 Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions. Properly structured and timed handoffs are essential to patient safety.1 Despite this, studies have shown that errors in code status, medication allergies, and important updates to the problem list are common, all of which can lead to adverse outcomes to patients.2
At Thomas Jefferson University Hospital (TJUH) the 2016 Safety Culture Survey revealed that across all specialties, 37% of residents felt that things “fall through the cracks” when transferring patients from one unit to another.
Our interdepartmental Housestaff Quality and Safety Leadership Council (HQSLC) sought to evaluate and modify the TJUH ICU to floor handoff process. Through engaging our diverse membership, we realized that the ICU to floor handoff process at TJUH lacks standardization. The following areas demonstrated a high degree of variation, and were seen as targets for improvement:
● Timing of handoff: Some departments give the handoff at the time of transfer order, and others at bed assignment.
● Incorporation of best practices: Both verbal and written handoffs should be performed with time for follow up questions by the receiving team
● Closed loop communication: Both sending and receiving teams should clearly communicate the plan of care, and the receiving team should clearly indicate when they have taken over primary responsibility.
Poster presented at: House Staff Quality and Safety Leadership Council conference at Thomas Jefferson University.
Improving Proficiency in Central Venous Catheter Insertion: Standardized Simulation Based Training for Internal Medicine House Staff
John Madara, MD; Christoph Hutchinson, MD, MA; and Frances Mae West, MD, MS
The objectives of this study are to assess residents' pre-workshop ability and comfort with CVC placement, undergo a standardized online didactic and hands-on clinical training simulation workshop, and subsequently undergo a proficiency test using simulation models to assess competency. The goal of a standardized training module is to create a universal approach to CVC placement in our institution and improve comfort and technical ability of house staff. We hypothesize that this will reduce complications and improve patient care and safety.
T. Conor McKee, MD and Christopher G. Roth, MD, MS-HQS
Objectives: Conduct Plan-Do-Study-Act (PDSA) performance improvement project to improve thyroid biopsy yield
Short Term>reduce unsuccessful biopsies by 50% Long-Term>eliminate unsuccessful biopsies
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)
T. Olszewski, K. Noonan, H. Gold, G. Kelly, and E. Youseef
In the postoperative course, patients are routinely encouraged to ambulate as frequently as possible. Typically in the hospital this can become burdensome to the staff and often becomes low priority. Patients are also not aware of the frequency and quality of the ambulation that is sufficient in the postoperative period. At present, patients on the surgical floor who are completely independent and without any devices (eg. Oxygen, nasogastric tubes, chest tubes) are freely able to ambulate at will although there is no reliable way to track this progress. Other patients with devices are limited to waiting for nursing or ancillary staff to assist them with securing the devices that they require in the postoperative period. Ambulation has been positively associated with decreased postoperative complications ranging from bowel function to deep venous thrombosis to pneumonia.
Increasing Effectiveness of the Surgical Airway Response System: Introduction of the Otolaryngology Airway Pager, Quality Improvement Project of the PGY-2 Class
Erin Reilly, MD; Lauren Galinat, MD; Ryan Rimmer, MD; Gregory Epps, MD; and Nikolaus Hjelm, MD
The need for an Otolaryngology airway pager is based on several external and internal factors. The current communication pathway for emergent airways at our institution is well established but often misinterpreted. The protocol is outlined in Figure 1. The priority to reach out to other departments is based on their availability of an attending in house overnight. Furthermore, there is often a delay in contacting the Otolaryngology department. Our service has multiple pagers to accommodate for each of our inpatient teams, which can be confusing for other services. One of the driving events for this project was an incident at JHN where a tracheostomy tube became dislodged. There were several attempts to contact our team through the wrong pager and by the time we were notified the patient had expired. In addition our personal cell phones are commonly used as the primary means of contact for urgent situations. On several occasions the wrong person has been called in the middle of the night or the on-call resident is contacted while they are in the operating room during the day, resulting in a slower response time. From the perspective of the Otolaryngology Department at times we receive multiple pages and answer in the order that the pages were received, not in order of acuity as this is unknown. A dedicated airway pager will help us prioritize our decisions most safely.
A. Rogers, T. Olszewski, N. Sich, and K. Noonan
Proposals and Goals:
1. We propose creating a standard easy to use and safe protocol for glycemic management for same day/elective surgical patients.
2. Following implementation in same day and elective surgical procedures, we propose expanding the protocol to be effective in urgent and emergent inpatient surgical procedures.
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.
Prabhu Senthil-Kumar, MD; Tanya Olszewski, MD; Robert Josloff, MD; and Kristin Noonan, MD
To limit narcotics use
Cochrane review: multiple studies have shown postoperative pain can be managed with non-narcotic meds with good outcome
Less medication related side effects:N/V, constipation, disorientation
Prevents substance addiction/abuse
N. Sich, L. Gartner, J. Sternlieb, and K. Noonan
Proposal and Goals:
We propose to create a standardized electronic procedure note that will replace all documentation for bedside procedures without sedation.
◦Makes notes legible and easily identified
◦Allows uniform tracking of metrics necessary to identify outcomes from a procedure (blood loss, specimens, post-procedure studies, complications)
2.The procedure note will be created in such a way as to allow specialized procedures to be added over time with minor customization to improve physician/nursing work flows and increase efficiency
◦Allows procedures to be sorted and tracked by type
◦Will be constructed to allow attaching CPT codes to patient charts via documentation
3. We propose using this procedure note to create a running database of all bedside procedures
◦Can be utilized by existing software (Qlik) to query all procedure notes to create large anonymized patient lists
Filling the Void: A Low Cost, High-Yield Method to Addressing Incidental Findings in Trauma Patients
N. Sich, A. Rogers, D. Bertozzi, P. Sabapathi, L. Gartner, W. Alswealmeen, P. Lim, J. Sternlieb, J. Yuschak, O. Kirton, and R. Shadis
In this study we:
Report the incidence of incidental findings in a suburban trauma center treating primarily blunt and elderly trauma
Propose simple solutions to increase the rate of disclosure to patients
Andrew Tseng; Kulvir Nandra, MD; Kelly Zabriskie; Phyllis Flomenberg, MD; and Scott W. Cowan, MD
To analyze CDI patterns to TJUH, particularly in Opportunity Units
To visually examine the relationship between CDI cases within units
Provide data analysis to the CDI working group
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.
Rady Ho, MD; Ravi Patel, MD; Matthew Zheng, MD; and Albert Lee, MD
We want to improve our colorectal screening rates for Tuesday JHAP patients to 40% by March 2016.
We will assess monthly rates of the % of patients who received CRC screening over the past 10 years.
This will improve overall health maintenance, and find/prevent pre-cancerous lesions. This potentially improves the life expectancy of our population.
Adam P. Johnson, MD, MPH; Ruben Rhoades, MD; Allison Greco, MD; Caitlyn Sidrane, MPH; Bracken Babula, MD; and Rebecca C. Jaffe, MD
Residents traditionally are under-engaged in event reporting through institutional channels.
The ACGME Clinical Learning Environment Review prioritizes this issue, and is establishing national benchmarks.
In 2015 the Housestaff Quality and Safety Leadership Council selected Increasing Error Reporting as their clinical quality initiative.
Benjamin Khazan, MD; Ankita Mehta, MD; Neena Mohan, MD; and Albert Lee, MD
Decrease the quantity of daily cigarettes smoked by 25% in cigarette smokers receiving their care at an ambulatory resident practice from January 2016 to May 2016.
Teresa Lee, MD; Shuwei Wang, MD; Susan Truong, MD; and Albert Lee, MD
To improve the arrival rate of patients at the Jefferson Hospital Ambulatory Practice (JHAP) by 10% over a 10-month period from July-April 2016 using a combination of additional reminder calls and targeted summaries from physicians.
To Fib or not to Fib: Misdiagnosis of Atrial Fibrillation on Telemetry: Case Presentation and Root Cause Analysis
Andrew W. Panakos, MD; Loheetha Ragupathi, MD; Sarah Feldman, RN; Brittany Heckel; Susannah Eckman; and Rebecca C. Jaffe, MD
Case presentation, current practices of telemetry management, root cause analysis, goals for improvement, proposed intervention and next steps.
Kinjal Parikh, MD; Shuwei Wang, MD; Kimberly Conway, RN; and Rebecca C. Jaffe, MD
"To minimize the number of missed or refused medications for inpatients so that adverse patient events such as PE or DVT are prevented"
SMART AIM: Within 3 months of initiating an EMR based electronic identification system for refused and missed medications, we will decrease the rate at which DVT prophylaxis was ordered however not eventually administered by 50%.
Taking the "e" out of Night "MARe" Rotation: Uncloaking Ghost Admissions via Teletracking and Reducing Paper Fatigue
Ramya Punati, MD; Jaehee Kim, MD; Rebecca C. Jaffe, MD; Lakshimi Ravindran, MD; and Bracken Babula, MD
To improve communication at admission for patients admitted from non-ED locations so that patient care delays are minimized and provider frustration decreases.
Ruben Rhoades, MD; Adam P. Johnson, MD, MPH; Rebecca C. Jaffe, MD; and Bracken Babula, MD
The ACGME Clinical Learning Environment Review (CLER) is driving a national re-evaluation of the engagement and alignment of housestaff in institutional Quality and Safety.
In 2008, the concept of a housestaff quality and safety committee was born, as a means of driving practice change
Our CLER data suggested that we need a similar council