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Improving the Patient Colonoscopy Prep Experience
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
AIM:
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
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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
AIM:
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.
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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
Objectives:
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
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Contact precautions-How patient centered are they?
Eloho Edosio, MD
Method:
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.
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Vaginal Preparation with Povidone Iodine prior to Cesarean Delivery
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
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Echocardiography role in syncope Patients
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.
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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
AIM:
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.
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Quality Review of Irradiated Cellular Blood Product Orders
Matthew Grzywinski and Vandy Ly, MD
Objectives:
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.
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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
Objective:
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.
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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
Objectives:
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.
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Philadelphia Drug Monitoring Program and Compliance with Department of Health Requirements
Paniz Heidari, DO; William Wieczorek, MD; Jayassree Iyer, MD; Denise Pineda-Fortin, MD; and Elizabeth Liveright, MD
Objectives:
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
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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
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Under Pressure: Ambulatory Blood Pressure Control
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.
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"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.
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Does Physician Education of Alternative Therapies for Obstructive Sleep Apnea Improve Utilization?
Colin Huntley, MD
Methods:
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.
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Consolidation of P2Y12 Testing While Maintaining Quality and Turnaround Time
Geetha Jagannathan, MBBS and Jerald Z. Gong, MD
Objective:
To consolidate the test performed at 2 different locations at 1, thereby improving cost effectiveness while maintaining quality and result turnaround time.
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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
Objectives:
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.
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Improving Pneumococcal Vaccination Rates in Jefferson Hospital Ambulatory Practice Patients
Kemarut Laothamatas, MD; Linda Yan, MD; Daniel Kramer, MD; and Matthew Enriquez, MD
AIM:
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.
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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
Methods:
Study sought to determine if an intervention would aid in increasing mammogram screening rates in the Jefferson Family Medicine Associates practice.
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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
Objectives:
We were interested in understanding patient perspectives regarding the importance of reviewing their imaging studies with a surgeon.
Specific Aims:
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?
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The Handoff Culture: Can we change how an ICU to floor transfer works?
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.
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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
Objectives:
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.
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Increasing Ultrasound-Guided Thyroid Biopsy Yield
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 -
Improving Colon Cancer Screening in a Resident Ambulatory Clinic
Newton Mei, MD; Grace Yang, MD; Mital Shah, MD; and Albert Lee, MD
AIM Statement:
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)
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Ambulation protocols leading to decreased postoperative complications and hospital stay
T. Olszewski, K. Noonan, H. Gold, G. Kelly, and E. Youseef
Background:
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.
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