Increasing Effectiveness of the Surgical Airway Response System: Introduction of the Otolaryngology Airway Pager, Quality Improvement Project of the PGY-2 Class

Introduction: 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.https://jdc.jefferson.edu/patientsafetyposters/1067/thumbnail.jp

Standardized Discharge Instructions and their Impact on Post Operative Patient Knowledge

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.https://jdc.jefferson.edu/patientsafetyposters/1082/thumbnail.jp

Moisture Chamber for Eye Care after Facial Nerve Injury

Introduction Patients with various lesions of the head and neck may have compromise of facial nerve function. Facial nerve (CN VII) has various roles, including movement of facial muscles and, importantly, eye closure. When facial nerve is sacrificed or damaged during a surgical cases, steps are often taken intraop to surgically correct the deficit and allow eye closure. However, these patients may not immediately realize the benefit of these interventions. In the postop period, appropriate eye care is critical to prevent exposure keratopathy due to inability to close eye. Exposure keratopathy is damage to the cornea that occurs primarily due to prolonged exposure of the ocular surface to the outside environment. It can lead to ulceration, microbial keratitis, and permanent vision loss from scarring.https://jdc.jefferson.edu/patientsafetyposters/1118/thumbnail.jp

Thyroid Cancer Metabolism: A Review

Abstract Metabolic dysregulation within the tumor microenvironment (TME) is critical to the process of tumorigenesis in various cancer types. Thyrocyte metabolism in papillary and anaplastic thyroid cancer, however, remains poorly characterized, and studies analyzing the role of multicompartment metabolism in thyrocyte oncogenesis are sparse. We present a review of the current knowledge on cellular metabolism in non-cancerous and cancerous thyroid tissues, focusing on the monocarboxylate transporters MCT1 and MCT4, and on a transporter of the outer mitochondrial membrane TOMM20. Understanding the metabolic phenotype of tumor cells and associated stromal cells in thyroid cancer can have profound implications on the use of biomarker staining in detecting subclinical cancer, imaging as it relates to expression of various transport proteins, and therapeutic interventions that manipulate this dysregulated tumor metabolism to halt tumorigenesis and eradicate the cancer. Future studies are required to confirm the prognostic significance of these biomarkers and their correlation with existing staging schemas such as the AGES, AMES, ATA and MACIS scoring systems. .https://jdc.jefferson.edu/otoposters/1002/thumbnail.jp