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Rapid Response Checklists - A Pilot Study For A Novel Approach, Ali Rafiq, MD, Purujit Thacker, MD, Doron Schneider, MD 2019 Abington Jefferson Health

Rapid Response Checklists - A Pilot Study For A Novel Approach, Ali Rafiq, Md, Purujit Thacker, Md, Doron Schneider, Md

House Staff Quality Improvement and Patient Safety Posters

Objective

Our goal was to assess residents' ability to think of adequate differential diagnoses in a high-pressure scenario, and their perception of the utility of a checklist during rapid responses.


Treatment Summaries For Head And Neck Cancer Survivors: Improving Patient Self Efficacy And Survivorship Care, Michael C. Topf, MD, Jena Patel, Ramez Philips, MD, David Cognetti, MD 2019 Thomas Jefferson University

Treatment Summaries For Head And Neck Cancer Survivors: Improving Patient Self Efficacy And Survivorship Care, Michael C. Topf, Md, Jena Patel, Ramez Philips, Md, David Cognetti, Md

House Staff Quality Improvement and Patient Safety Posters

Objective

  • To determine if receiving treatment summaries enhances patient understanding and recall of cancer and treatment details, improves patient self efficacy, and serves as a useful patient tool after completion of head and neck (HNC) therapy


“Can You Send Over The Imaging?” Analyzing The Patient Transfer Process At Tjuh, Walker Lyons, MD, Peter Altshuler, MD, Andrew Hallett, MD, Lindsay Lynch, MD, Tommy O'Malley, MD, Steven Woodward, MD, Alicja Zalewski, MD, Scott Cowan, MD 2019 Thomas Jefferson University

“Can You Send Over The Imaging?” Analyzing The Patient Transfer Process At Tjuh, Walker Lyons, Md, Peter Altshuler, Md, Andrew Hallett, Md, Lindsay Lynch, Md, Tommy O'Malley, Md, Steven Woodward, Md, Alicja Zalewski, Md, Scott Cowan, Md

House Staff Quality Improvement and Patient Safety Posters

Objective

Our goal was to investigate possible ways to improve the transition of care when patients are transferred to Jefferson Center City. As a quaternary care hospital with a large transfer volume, it is especially important to look for ways to optimize this process because it can improve timely patient care, reduce and eliminate unnecessary studies and diagnostic tests and save time and work that could be better spent in other aspects of treating the patient.


Improving Screening For Diabetic Retinopathy In An Ambulatory Resident Clinic, R. Benson Jones, Guy Katz, Jon Zaid, Navdeep Sangha, Rebecca Davis 2019 Thomas Jefferson University

Improving Screening For Diabetic Retinopathy In An Ambulatory Resident Clinic, R. Benson Jones, Guy Katz, Jon Zaid, Navdeep Sangha, Rebecca Davis

House Staff Quality Improvement and Patient Safety Posters

Introduction

While 60% of Americans with diabetes are screened for diabetic retinopathy, the residents in the Jefferson Internal Medicine Associates (JIMA) ambulatory clinic had a lower screening rate (roughly 50%).(1) Our project aimed to increase that screening rate.


Neuroimaging Protocol In Patients Presenting With Spontaneous Intracerebral Hemorrhage, Kevin Hines, MD, Nikolaos Mouchtouris, MD, Karim Hafazalla, Jacob M. Mazza, Phillip Phan, Giuliana Labella, Muhammad Athar, MD, Adam Flanders, MD, Pascal Jabbour, MD 2019 Thomas Jefferson University

Neuroimaging Protocol In Patients Presenting With Spontaneous Intracerebral Hemorrhage, Kevin Hines, Md, Nikolaos Mouchtouris, Md, Karim Hafazalla, Jacob M. Mazza, Phillip Phan, Giuliana Labella, Muhammad Athar, Md, Adam Flanders, Md, Pascal Jabbour, Md

House Staff Quality Improvement and Patient Safety Posters

Introduction

While lacking evidence based recommendations, most institutions must evaluate spontaneous intracerebral hemorrhages (sICH) for hematoma expansion (HE). If unrecognized, it can be a devastating complication. However, because of the lack of general recommendations for serial imaging, many hospitals, including Thomas Jefferson, have arbitrarily instituted 6 hour an 24 hour stability head CT’s to evaluate for HE.

In our project, we examine the impact of this imaging protocol on the safety and quality of patient care and provide revised recommendations for imaging in sICH at Thomas Jefferson University Hospital and Jefferson Hospital for Neuroscience.


Aspiration Pneumonia After Spine Surgery At Tjuh, Daniel Franco, MD, Jesse Edwards, MD, Kristen Vogl, PT, Barbara Baskin, SLP, James Harrop, MD 2019 Thomas Jefferson University

Aspiration Pneumonia After Spine Surgery At Tjuh, Daniel Franco, Md, Jesse Edwards, Md, Kristen Vogl, Pt, Barbara Baskin, Slp, James Harrop, Md

House Staff Quality Improvement and Patient Safety Posters

Problem Definition

Aspiration Pneumonia after Spine Surgery at TJUH has a disproportionately high incidence, compared to other major academic centers When Aspiration Pneumonia is diagnosed in the immediate post operative period, this cascades into increased length of stay, increased overall cost and possibility negative impact for physician and hospital reimbursement At this time, it is unclear which criteria are used by physicians to determine whether an aspiration event has happened.


Small Bowel Obstruction: Facilitating Diagnosis And Optimizing Resuscitation And Management, Robin Naples, MD, Kendrick Law, MD, Quinton Campbell, MD, Ryan Bateman, MD 2019 Thomas Jefferson University

Small Bowel Obstruction: Facilitating Diagnosis And Optimizing Resuscitation And Management, Robin Naples, Md, Kendrick Law, Md, Quinton Campbell, Md, Ryan Bateman, Md

House Staff Quality Improvement and Patient Safety Posters

Introduction

As a common surgical emergency that presents in our Emergency Department, Small Bowel Obstruction (SBO) is a disease process where appropriate treatment relies on early detection, fluid resuscitation, and gastric decompression. Despite SBO representing a common emergency, many patients experience inadequate or delayed management as compared to established guidelines, potentially leading to suboptimal treatment and resolution of SBO. As order sets and alerts within Epic are in place for other disease processes whose management relies on timely diagnosis and fluid resuscitation (e.g. sepsis), objectives for our quality improvement plan involve incorporating elements of alerts and order sets within ...


Scanning For Qi: Resident And Sonographer Driven Improvement Of Radiology Resident Ultrasound Technique, Brian Blumhof, MD, Corinne Wessner, BS, RDMS, RVT, Kristen McClure, MD 2019 Thomas Jefferson University

Scanning For Qi: Resident And Sonographer Driven Improvement Of Radiology Resident Ultrasound Technique, Brian Blumhof, Md, Corinne Wessner, Bs, Rdms, Rvt, Kristen Mcclure, Md

House Staff Quality Improvement and Patient Safety Posters

Objective

The aim of this structural QI project is to improve the educational ultrasound curriculum , thus improving overall resident confidence and technical ability in acquiring diagnostic quality sonographic images.

Comparing resident confidence levels and performance against their initial benchmarks as well as against yearly cohorts, we plan to create a long standing addition to the radiology residency at Jefferson, with plans to include additional ultrasound examinations as the curriculum becomes more robust.

Stakeholders include not only the radiology residency, which would benefit from improved resident education and knowledge, but also the hospital and ultimately patients, who stand to benefit from ...


Escalation Of Care After Admission Within 24 Hours, Joseph Jean, MD, Mitchell Berman, MD, Christopher Ponce, MD, Kory London, MD 2019 Thomas Jefferson University

Escalation Of Care After Admission Within 24 Hours, Joseph Jean, Md, Mitchell Berman, Md, Christopher Ponce, Md, Kory London, Md

House Staff Quality Improvement and Patient Safety Posters

Objectives

  1. Identify high risk patients in the ED who require hospital admission and may need higher levels of care.
  2. Identify patterns or diagnoses in the ED that predispose patient care to escalations after admission.


Implementation Of A Volunteer Based Hospital Visitation Program For Older Adults, Mariana R. Kuperman, MD, MPH, Kristine Swartz, MD, Elizabeth Collins, MD, Jennifer Kim, BS 2019 Thomas Jefferson University

Implementation Of A Volunteer Based Hospital Visitation Program For Older Adults, Mariana R. Kuperman, Md, Mph, Kristine Swartz, Md, Elizabeth Collins, Md, Jennifer Kim, Bs

House Staff Quality Improvement and Patient Safety Posters

Background

Hospital Elder Life Program (HELP)¹: a multi faceted, volunteer led, hospital based program has been shown to:

  • Reduce the incidence of delirium
  • Decrease length of stay
  • Reduce hospital costs

Implementation of such a program requires upfront investment.

A smaller, volunteer based visitation program for older adults was started to provide support for the allocation of hospital resources in delirium prevention and establishment of HELP in this institution.

This research aims to investigate the program’s implementation and impact on delirium specific outcomes.


We Got The Beat: Improving Cpr Quality With Real-Time Metrics, Juergen Kloo, MD, Frances Mae West, MD, Michael Haviland, RN, BSN 2019 Thomas Jefferson University

We Got The Beat: Improving Cpr Quality With Real-Time Metrics, Juergen Kloo, Md, Frances Mae West, Md, Michael Haviland, Rn, Bsn

House Staff Quality Improvement and Patient Safety Posters

Introduction

High quality chest compressions have been linked to improved survival from sudden cardiac arrest.

The 2015 AHA guidelines recommend the following:

  • Rate of compressions between 100 120 CPM
  • Depth of compressions between 2 2.4 inches
  • Allow full recoil between compressions
  • Target CPR fraction at least 60% of the time, ideally 80%
  • Avoid hyperventilation
  • Collect and use data to improve performance

We set out to show that our clinicians would have a minimum 25% improvement in CPR quality with the use of real time feedback using the new R series ZOLL defibrillators.


Time Outs Take Teamwork Improving Patient Safety For Bedside Procedures, Thana Theofanis, MD, Adam Johnson, MD, MPH, Jennifer Harris, MD, Elly Fitzpatrick, RN, Darlene Rosendale, RN, Rebecca Jaffe, MD 2019 Thomas Jefferson University

Time Outs Take Teamwork Improving Patient Safety For Bedside Procedures, Thana Theofanis, Md, Adam Johnson, Md, Mph, Jennifer Harris, Md, Elly Fitzpatrick, Rn, Darlene Rosendale, Rn, Rebecca Jaffe, Md

House Staff Quality Improvement and Patient Safety Posters

Aims for Improvement

Mission: Improve patient safety through increasing interprofessional collaboration and empowerment in the peri procedural time periods.

Aims

  • Increase rate of high quality time outs performed prior to bedside procedures by 50%
  • Increase rate of accurate and timely timeout documentation by 50%


Improving Residents’ Response Time To Inbox Results, Sean Hurt, MD, Rose Onyeali, MD, Jason Ojeda, MD 2019 Thomas Jefferson University

Improving Residents’ Response Time To Inbox Results, Sean Hurt, Md, Rose Onyeali, Md, Jason Ojeda, Md

House Staff Quality Improvement and Patient Safety Posters

Study Aims

  • We aimed to improve the response times to inbox results of the residents and interns at Jefferson Internal Medicine Associates. A standard measure in EPIC is the percentage of inbox results responded to within 24 hours. At the time of project initiation, 50% of all results assigned to resident and intern inboxes were being responded to in this time frame . We aimed to improve this number to 70%
  • There is no expectation that residents and interns could respond to all results within 24 hours. Trainee schedules are very crowded, and not all inbox results need to be responded ...


Expedited Referral To Inpatient Hospice Unit Through The Jefferson Methodist Hospital Emergency Department, Brian Fromm, MD, Kory London, MD, FACEP 2019 Thomas Jefferson University

Expedited Referral To Inpatient Hospice Unit Through The Jefferson Methodist Hospital Emergency Department, Brian Fromm, Md, Kory London, Md, Facep

House Staff Quality Improvement and Patient Safety Posters

Background

Palliative care is the branch of healthcare that aims to provide symptomatic relief for patients with chronic or incurable medical conditions. Hospice is a subcategory of palliative care in which the focus is placed on comfort to the exclusion of further curative efforts, generally reserved for patients with a life expectancy of six months or less.

The American College of Emergency Physicians (ACEP) Choosing Wisely guidelines recommend that emergency physicians refer appropriate patients to hospice and palliative services. Preventing hospital admission in favor of transfer to an inpatient hospice unit “can benefit select patients resulting in both improved quality ...


Optimizing Resident Clinic Efficiency Through Process Flow Analysis, Michael Abendroth, MD, MBA, Saumya Copparam, MD, Qiang Zhang, PhD, Rose Costello, MA, Tara Uhler, MD, Robert Bailey, MD 2019 Thomas Jefferson University

Optimizing Resident Clinic Efficiency Through Process Flow Analysis, Michael Abendroth, Md, Mba, Saumya Copparam, Md, Qiang Zhang, Phd, Rose Costello, Ma, Tara Uhler, Md, Robert Bailey, Md

House Staff Quality Improvement and Patient Safety Posters

Abstract

Introduction: Clinic process inefficiencies cause lengthy visit and wait times, which frustrate patients and providers and limit clinic capacity

Objective: To identify process inefficiencies and assess process flow interventions

Methods: Prospective, consecutive series of resident clinic visits over a 3-week period after transferring refraction from tech to resident. Personnel recorded the time spent waiting for and undergoing each clinic process. The clinic also piloted a “Fast Track” from registration to resident for appropriate established patients.

Results: Patients spent 53% of the visit waiting, primarily for the tech. Transferring refraction from tech to resident decreased the wait for tech and ...


A Strategy For Noise Reduction To Improve Patient Experiences With Sleep (Snores), Vikas Sunder, Eitan Frankel, Neelam Upadhyaya, Merlin Mathew, Ritu Nahar, Michael Brister, Nicholas Young, Yair Lev, MD 2019 Thomas Jefferson University

A Strategy For Noise Reduction To Improve Patient Experiences With Sleep (Snores), Vikas Sunder, Eitan Frankel, Neelam Upadhyaya, Merlin Mathew, Ritu Nahar, Michael Brister, Nicholas Young, Yair Lev, Md

House Staff Quality Improvement and Patient Safety Posters

Aim

Our aim was to improve patient-reported sleep satisfaction on the 5 W telemetry unit at Thomas Jefferson University Hospital over a 4 month time period (11/2018 to 2/2019) using a Marpac white noise machine.


Developing A Neurosurgical Spine Post-Operative Note Template On Epic For Improved Multi-Disciplinary Care, Omaditya Khanna, MD, Geoffrey P. Stricsek, MD, Giuliana Labella, RN, James Harrop, MD, Jesse Edwards, MD 2019 Thomas Jefferson University

Developing A Neurosurgical Spine Post-Operative Note Template On Epic For Improved Multi-Disciplinary Care, Omaditya Khanna, Md, Geoffrey P. Stricsek, Md, Giuliana Labella, Rn, James Harrop, Md, Jesse Edwards, Md

House Staff Quality Improvement and Patient Safety Posters

Introduction

The care of neurosurgical spine patients often involves a multi-disciplinary team, including neurosurgery residents, hospitalists, nursing staff, and physical/occupational therapists.

Oftentimes, post-op spine patients are on a non-neurosurgical service (hospitalist, MICU/SICU, medicine), who are provided with scant sign out on the procedure(s) performed.

The treatment team(s) that are helping manage patient care post-operatively are often unaware of the procedure performed, and what are the salient clinical signs/symptoms, radiographic findings, and laboratory values that need to be closely monitored


A Qi Initiative To Reduce Time To Antibiotics In Oncologic Neutropenic Fever, Adam Binder, Jordan Villars 2019 Thomas Jefferson University

A Qi Initiative To Reduce Time To Antibiotics In Oncologic Neutropenic Fever, Adam Binder, Jordan Villars

House Staff Quality Improvement and Patient Safety Posters

Problem Statement

Neutropenic fever (NF) (defined as temperature of 101o F on one occasion, or 100.4o F sustained over 60 minutes in a patient with an absolute neutrophil count (ANC) less than 500, or suspected drop below 500 within 48 hours) is relatively common oncologic emergency, particularly in hematologic malignancy patients. Expert consensus is that anti-pseudomonas gram-negative antibiotics (abx) should be administered within 60 minutes of detecting neutropenic fever.

At Thomas Jefferson University Hospital (TJUH), internal guidelines for time to treatment in neutropenic fever are in line with expert consensus - 60 minutes. We found that from July 1st – November ...


Application Of Alvimopan As A Component Of Enhanced Recovery After Surgery (Eras) Protocol For Patients Undergoing Radical Cystectomy And Diversion (C&D), Thomas Hardacker, MD, MBA, May Jean Counsilman, MD, Benjamin H. Rudnick, MD, Edouard J. Trabulsi, MD, James R. Mark, MD, Leonard G. Gomella, MD, Mark J. Mann, MD, Costas D. Lallas, MD, Scott G. Hubosky, MD 2019 Thomas Jefferson University

Application Of Alvimopan As A Component Of Enhanced Recovery After Surgery (Eras) Protocol For Patients Undergoing Radical Cystectomy And Diversion (C&D), Thomas Hardacker, Md, Mba, May Jean Counsilman, Md, Benjamin H. Rudnick, Md, Edouard J. Trabulsi, Md, James R. Mark, Md, Leonard G. Gomella, Md, Mark J. Mann, Md, Costas D. Lallas, Md, Scott G. Hubosky, Md

House Staff Quality Improvement and Patient Safety Posters

Introduction

  • Radical cystectomy with urinary diversion (C&D) is performed for patients with muscle-invasive bladder cancer (MIBC) or refractory carcinoma in situ (CIS)
  • C&D patients receive one of several types of diversion depending on their age, comorbidities, functional status, and extent of disease (Figure 1)
  • Post-operative length of stay (LOS) can be prolonged (9-11 days) and 30 day readmission rates and mortality elevated (30% and 1.5%); return of bowel function usually the rate-limiting step to discharge
  • Enhanced Recovery After Surgery (ERAS) protocols utilize pre-, intra-, and postoperative elements in order to improve return of bowel function and decrease LOS
  • Alvimopan is a μ-opioid receptor antagonist commonly included in ERAS, and limits deleterious effects of narcotics on the GI system
  • The goal of this analysis was to determine the effect of Alvimopan on post-operative LOS and 30 day readmission in patients undergoing C&D


Implementation Of A ‘Flow’ Attending Reduces Overall Ed Length Of Stay In Telehealth Intake Model, R. Fuega, K. Maloney, R. A. Band, B. H. Slovis, K. S. London, J. L. White 2019 Thomas Jefferson University

Implementation Of A ‘Flow’ Attending Reduces Overall Ed Length Of Stay In Telehealth Intake Model, R. Fuega, K. Maloney, R. A. Band, B. H. Slovis, K. S. London, J. L. White

House Staff Quality Improvement and Patient Safety Posters

Background

In an effort to improve our efficiency, the Department of Emergency Medicine recently transitioned from an in person physician triage model to a telehealth intake model. With this change, many new gaps have been identified. By uncoupling triage from the in person intake provider, we lost the ability to manage “quick” discharges, to provide secondary oversight of the patients in the internal waiting room, and to directly supervise patients seen in the fast track area. In order to address these new concerns, and to mitigate the loss felt by removing the in person provider from intake, a ‘flow’ attending ...


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